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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: Rick Spady <br /> Permittee Company: Kiowa County <br /> Address: P.O. Box 100 <br /> Eads, CO 81036 <br /> Phone Number: (719)438-5810 <br /> Fax Number: (719)438-5327 <br /> Email Address: <br /> Permitting Contact: Rick Spady <br /> Company: Kiowa County <br /> Address: P.O. Box 100 <br /> Eads,CO 81036 <br /> Phone Number: (719)438-5810 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Rick Spady <br /> Company: Kiowa County <br /> Address: P.O. Box 591 <br /> Eads, CO 81036 <br /> Phone Number: (719)438-5810 <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 conducted in accordance with the Division approved mining and reclamation plans. <br /> e4;)Yt <br /> -i3 <br /> Sign ure of Perm' tee,C porate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />