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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: Lex Nichols <br /> Permittee Company: Otero County <br /> Address: 13 W. 3rd St.,Room 208 <br /> La Junta,CO 81050 <br /> Phone Number: (719)383-3035 <br /> Fax Number: <br /> Email Address: Lnichols@oterogov.org <br /> Permitting Contact: Lex Nichols <br /> Company: Otero County <br /> Address: 13 W. 3rd St., Room 208 <br /> La Junta, CO 81050 <br /> Phone Number: (719)383-3035 <br /> Fax Number: <br /> Email Address: Lnichols@oterogov.org <br /> Inspection Contact: Lex Nichols <br /> Company: Otero County <br /> Address: 13 West 3rd St., Room 208 <br /> La Junta, CO 81050 <br /> Phone Number: (719)383-3035 <br /> Fax Number: <br /> Email Address: Lnichols@oterogov.org <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 a proved mining and reclamation plans. <br /> 7711 <br /> Signature of Per ,ittee Coro ate fficer,Wner,or Documented Designee Date <br /> M-AF-04 <br />