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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: Jeffrey D.Coonts <br /> Permittee Company: Lincoln County <br /> Address: P.O. Box 39 <br /> Hugo, CO 80821 <br /> Phone Number: (719)743-2337 <br /> Fax Number: (719)743-2815 <br /> Email Address: Dnr—dn-nsminadmin@state.co.us „/�� S e �2'11 e'oIiq eotc n f CB, uS <br /> Permitting Contact: John DeWitt Y64jw'e 5- <br /> Company: Lincoln County <br /> Address: P.O. Box 39 <br /> Hugo, CO 80821 <br /> Phone Number: (719)743-2337 <br /> Fax Number: (719)743-2815 <br /> Email Address: Ce /4'(u -e ��SNC7 Lvuhf CO_ LcS v <br /> Inspection Contact: John DeWitt <br /> Company: Lincoln County <br /> Address: P.O. Box 39 <br /> Hugo,CO 80821 <br /> Phone Number: (719)743-2337 <br /> Fax Number: (719)743-2815 Email Address: Ze(6t oie(kt S-e 6V Ztn e-64? cak»'f ®. a S <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 60ermlfittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />