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Page 5 of 5 <br /> <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 /> <br />Permittee Contact: <br /> <br />Stephen J. Cohen <br />Permittee Company: <br /> <br />Cotter Corporation <br />Address: <br /> <br /> <br /> <br />7800 E. Dorado Place, Suite 210 <br />Greenwood Village, CO 80111 <br /> <br />Phone Number: <br /> <br />(720) 554-6200 <br />Fax Number: (720) 554-6201 <br />Email Address: Steve.cohen@cotterusa.com <br />Permitting Contact: <br /> <br />John Hamrick <br />Company: <br /> <br />Cotter Corporation <br />Address: <br /> <br /> <br /> <br />0502 County Road 68 <br />P.O. Box 1750 <br />Canon City, CO 81212 <br /> <br />Phone Number: <br /> <br />(719) 275-7413 <br />Fax Number: (719) 275-1669 <br />Email Address: <br />Inspection Contact: <br /> <br />John Hamrick <br />Company: <br /> <br />Cotter Corporation <br />Address: <br /> <br /> <br /> <br /> <br />P.O. Box 1750 <br />Canon City, CO 81215 <br /> <br />Phone Number: <br /> <br />(719) 275-7413 <br />Fax Number: (719) 275-1669 <br />Email Address: <br /> <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 /> <br /> <br /> <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date <br />M-AF-02