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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: Brad Palmer <br /> Permittee Company: Lake County <br /> Address: P.O. Box 952 <br /> Leadville,CO 80461 <br /> Phone Number: (719)486-0259 <br /> Fax Number: (719)486-8479 <br /> Email Address: Bpalmer@co.lake.co.us <br /> Permitting Contact: Kent Hager 'PUA'It' <br /> Company: Lake County <br /> LAM <br /> Address: County Administrator 6. aX gr7Z <br /> P.O. Box 964 �2� IZ sy$i <br /> Leadville,CO 80461 <br /> Lfetalt <br /> Phone Number: (719)486-0993 <br /> ! �l86 <br /> Fax Number: Ll plOIO _ <br /> Email Address: 0 <br /> rKrRwkJ L� Ca, We?. Cv . r,lS <br /> Inspection Contact: Steve Kleeberger <br /> Company: Lake County <br /> i <br /> Address: Road&Bridge Supervisor A*Wj;y-,q.�! 12,r-,0fe,e S2 G ,64tZ kvc*5 <br /> P.O. Box 964 -e 0. 5 Z <br /> Leadville,CO 80461 4-t79 sr <br /> Phone Number: (719)486-0993 <br /> Fax Number: 'T <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 /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />