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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: Brad Palmer <br /> Permittee Company: Lake County <br /> Address: P.O. Box 952 <br /> Leadville, CO 80461 <br /> Phone Number: (719)486-0259 <br /> Fax Number: (719)486-8479 <br /> Email Address: •����� /��. � - � <br /> Permitting Contact: .Catkerim- affi <br /> Company: Lake County <br /> Address: P.O. Box 964 <br /> Leadville,CO 80461 �Z / <br /> Phone Number: (719)486--4-t95 <br /> Fax Number: (719)486-4.147 <br /> Email Address: Yd <br /> Inspection Contact: a K.Ieobet'ger <br /> Company: Lake County <br /> Address: P.O. Box 96,4" <br /> Leadville,CO 80461 <br /> Phone Number: (719)486-4W45-- <br /> Fax Number: (719)486-4117 / <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 or ance with the Division approved mining and reclamation plans. <br /> Signature of PernitteeUorporate Officer,Owner,or Documented Documented Designee Date <br /> M-AF-04 <br />