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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: Tammie Crawford / <br /> Permittee Company: Park County -> <br /> Address: P.O. Box 147 <br /> Fairplay,CO 80440 <br /> Phone Number: (719)836-4283 <br /> Fax Number: (719)836-4275 <br /> Email Address: Tcrawford@parkco.us , <br /> Permitting Contact: Doug Keith <br /> Company: Park County <br /> Address: P.O. Box 147 <br /> Fairplay, CO 80440 <br /> Phone Number: (719)836-4282 <br /> Fax Number: (719)836-4275 <br /> Email Address: <br /> Inspection Contact: Doug Keith <br /> Company: Park County <br /> Address: P.O. Box 147 <br /> Fairplay,CO 80440 <br /> Phone Number: (719)836-4282 <br /> Fax Number: (719)836-4275 <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 /> Signature of Permitt e C4borate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />