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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: Ina Finch <br /> Permittee Company: Indian Springs Ranch, LLP <br /> Address: P.O. Box 405 <br /> Canon City, CO 81212 <br /> Phone Number: (719)275-5003 <br /> Fax Number: 8 <br /> Email Address: I <br /> Permitting Contact: Ina Finch <br /> Company: Indian Springs Ranch,LLP <br /> Address: 3257 CR 67 <br /> Penrose,CO 81240 <br /> Phone Number: (719)275-5003 <br /> Fax Number: fl"%!f— <br /> Email Address: ©r+M-1t5 Cis Q I <br /> Inspection Contact: Ina Finch <br /> Company: Indian Springs Ranch, LLP <br /> Address: 3257 CR 67 <br /> Penrose,CO 81240 <br /> Phone Number: (719)275-5003 <br /> Fax Number: -- <br /> Email Address: <br /> 1nC.�1 oIru ��c rnu <br /> I,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 mini n nd reclamation plans. <br /> Signature of Permittee,Corporate Officer,Owner,or DocumenfeA Designee ate <br /> M-AF-01 <br />