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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: "-4be iz=--Nm- ""cirRTi`,—sr— <br /> tj <br /> 5�15', GA�II.- Z1m M A <br /> Permittee Company: C,A-t -- c Ltt- M/✓ eie-A <br /> la Nesselhuf _ <br /> Address: 31738 County Road 13 �qpo 2- C 0 J 4—C-I pep CC <br /> Manzanola, CO 81058 <br /> Phone Number: (719)462-5236 L aL A - <br /> 4-�" a loci 0 &Alms -T l q ZS:s Z— <br /> Fax Number: <br /> Email Address: /17 m E C/nall C 5+'r14 <br /> 5 �? <br /> Permitting Contact: Xlbert F.Nesselhuf,Jr. <br /> (At L- Z(Vn fu <br /> Company: Will' m&Be erly Caldwell and <br /> Albert Lgla Nesselhuf <br /> Address: 31738 016knly Road 13 <br /> Manz a a, O 81058 <br /> Phone Number: <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: <br /> &A��---Z i vvI m�lZ�,A-il <br /> Company: illia &Beverly Caldwell and <br /> A e &Lola Nesselhuf <br /> Address: 3 %�za <br /> ounty Road 13 <br /> Mola, CO 81058 <br /> Phone Number: - <br /> Fax Number: <br /> Email Address: <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 /> 0'/V�- C—, -t— '612-1 20 <br /> L7 <br /> Signa re of Permittej,Co orate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />