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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: David P. Morlan <br /> Permittee Company: Rio Blanco County <br /> Address: 570 2nd St. <br /> Meeker,CO 81641 <br /> Phone Number: (970)878-9590 <br /> Fax Number: (970)878-3396 <br /> Email Address: David.morlan@rbc.us <br /> Permitting Contact: n._,- _a T, TT"a <br /> C.li"A CkA ell All' <br /> Company: Rio Blanco County <br /> Address: <br /> M �76 S e Cow S�. <br /> Meeker,CO 81641 � <br /> Phone Number: 9 76 — 9 7" — Q <br /> Fax Number: p 7Q , $7.9 , 3.3 4G <br /> Email Address: 1 <br /> CI n/ �✓a e �. V S � <br /> Inspection Contact: v <br /> Company: Rio Blanco County <br /> Address: t-Ic S 76 S e <br /> Meeker, CO 81641 v <br /> Phone Number: <br /> Fax Number: 4 7a - 1W7&^ <br /> Email Address: CWA-if. Gk <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 /> i z/.4i, i1Z <br /> Signs a of ermittee Co orate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />