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Page 5 of 5 <br /> Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have <br /> information on record). if this information is blank or not current,please type or print current contact information: <br /> Permittee Contact: Scott Davis <br /> Permittee Company: Schmidt Construction Company <br /> Address: 2635 Delta Dr. <br /> Colorado Springs,CO 80910 <br /> Phone Number: (719)392-4207 <br /> Fax Number: (719)392-4245 <br /> Email Address: Sdavis@schmidtconstr.com <br /> Permitting Contact: Scott Davis <br /> Company: Schmidt Construction Company <br /> Address: 2635 Delta Dr. <br /> Colorado Springs,CO 80910 <br /> Phone Number. (719)392-4207 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Scott Davis <br /> Company: Schmidt Construction Company <br /> Address: 2635 Delta Dr. <br /> Colorado Springs,CO 80910 <br /> Phone Number. (719)392-4207 <br /> Fax Number: <br /> Email Address: <br /> 1,the undersigned,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> being conducted in accordance with the Division approved mining and reclamation plans. <br /> a" - r <br /> . — > <br /> Signature o ermittee.Corporate Officer,Owner,or pied Desh nee Date <br /> M•AF-01 <br />