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4 <br /> 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: Stanley Rasmussen - 'f`c hp e 1 I <br /> c.1 11� <br /> Company: Rio Blanco County <br /> Address: 17497 Hwy. 64 tt <br /> Rangely, CO 81648 676 Se-cpm d <br /> Phone Number: (970)675-8644 <br /> q70 <br /> Fax Number: (970)675-5211 <br /> Email Address: <br /> cl �� e <br /> Inspection Contact: Stanley Rasmussen <br /> l <br /> Company: Rio Blanco County <br /> t a 2 1 <br /> Address: 17497 Hwy. 64 <br /> Rangely, CO 81648 S'7 6 5eCo%1<1 S fi- <br /> n� cd 5-11 LY 1 <br /> Phone Number: (970)675-8644 � <br /> 976 ' 9 7 8'' 9 5'9d <br /> Fax Number: (970)675-5211 <br /> 9 70 - 'i� 75 - 3 39 9 v <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 conducted in accordance with the Division approved mining and reclamation plans. <br /> e�zz�e�- - /%.V, .-�- Y/7 <br /> Sodfiture of Vermittee,Q&pdrate Officer,Owner,or Documented Desianee Date <br /> M-AF-04 <br />