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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: Marlene D.Crosby <br /> Permittee Company: Gunnison County <br /> Address: 195 Basin Park Dr. <br /> Gunnison, CO 81230 <br /> Phone Number: (970)641-0044 <br /> Fax Number: (970)641-8120 <br /> Email Address: Mcrosby@gunnisonounty.org <br /> Permitting Contact: <br /> Ken Ashwovd— <br /> Marlene D. Crosby <br /> Company: Gunnison County <br /> Address: _o,, n:.. G..,,_d_ <br /> 195 Basin Park Drive <br /> Gunnison, CO 81230 <br /> Phone Number: (970)641-0044 <br /> Fax Number: ( 9 7 0) 641 —8120 <br /> Email Address: mcrosby@gunnisoncounty.org <br /> Inspection Contact: Marlene D. Crosby <br /> Company: Gunnison County <br /> Address: 8i t Rio Efla 195 Basin Park Drive <br /> Gunnison, CO 81230 <br /> Phone Number: (970)641-0044 <br /> Fax Number: ( 9 70 ) 641 —8120 <br /> Email Address: <br /> mcrosby@gunnisoncounty.org <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 /> r <br /> 6111 <br /> Si n ture of Permittee Coriporate O er,Owner,or Documented Designee Date <br /> M-AF-04 <br /> � I <br />