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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—drmsminadmin@state-co.us Z6LENA"GGSt �a FjGB'!�'f COL(Hf Co. zll <br /> Permitting 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 <br /> Email Address: <br /> Z C ( �G/ �2 L[f?G�I/► G BGYh� G0, LC S <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 / <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 /> Signat f P ittee Corporate Officer,Owner,or Documented DesiEnee Date <br /> M-AF-04 <br />