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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: T.E.Allumbaugh <br /> Permittee Company: Crowley County <br /> Address: 603 Main St. Ste. 2 <br /> Ordway,CO 81063 <br /> Phone Number: (719)267-5555 <br /> Fax Number: (719)267-3114 <br /> Email Address: Tobe@crowleycounty.net <br /> Permitting Contact: Carol Mumm <br /> Company: Crowley County <br /> Address: 110 E 6th St <br /> Ordway, CO 81063 <br /> Phone Number: (719)267-3248 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Carol Mumm <br /> Company: Crowley County <br /> Address: 110 E 6th St <br /> Ordway, CO 81063 <br /> Phone Number: (719)267-3248 <br /> Fax Number: <br /> Email Address: <br /> I,the undersigned,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> being onducted in accordance with the Division approved mining and reclamation plans. <br /> �� �►,� �,� �s cKJf;2s --Z/- <br /> Si2dature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />