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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: Rob Englehart <br /> Permittee Company: Montezuma County <br /> Address: 109 West Main Street <br /> Cortez, CO 81321 <br /> Phone Number: (970)565-8666 <br /> Fax Number: <br /> Email Address: Renglehart@co.montezuma.co.us <br /> Permitting Contact: <br /> Rob Cn leln ar� <br /> Company: Montezuma-County <br /> Address: 109 West Main Street <br /> Cortez, CO 81321 <br /> Phone Number: (970)565-8666 <br /> Fax Number: 0) 5� <br /> Email Address: um . <br /> rQ'r <br /> Inspection Contact: <br /> o F � <br /> Company: Montezum ounty <br /> Address: 109 West Main Street <br /> Cortez,CO 81321 <br /> Phone Number: (970)565-8666 <br /> Fax Number: <br /> O <br /> Email Address: <br /> rtfl <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 mining and reclamation plans. <br /> IL <br /> Signature of Per ee CorDbrate Officer,Owner,or Documented Designee Date v <br /> M-AF-04 <br />