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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: David P.Morlan <br /> Permittee Company: Rio Blanco County <br /> Address: 570 2nd St. <br /> Meeker, CO 81641 <br /> Phone Number: (970)878-9590 <br /> Fax Number: (970)878-3396 <br /> Email Address: David.morlan@rbc.us <br /> Permitting Contact: Jerry Steele C <br /> Company: Rio Blanco County <br /> R;o eou�J <br /> Address: P.O. Box KK 5-70 5eCcN <br /> Meeker, CO 81641 <br /> Phone Number: (970)878-5601 <br /> 970 g790- S a � <br /> Fax Number: 76 79 - 3 3 G <br /> Email Address: v <br /> Inspection Contact: Jerry Steele <br /> Company: Rio Blanco County k',Q <br /> Address: P.O. Box KK <br /> Meeker,CO 81641 <br /> Yt�eel�er, cd �1��11 � <br /> Phone Number: (970)878-5601 9 <br /> Fax Number: <br /> Email Address: <br /> C U <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 /> gnature of Permittee,Co porate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />