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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: <br />Wayne Caldwell <br />Permittee' Company: <br />Caldwell Brothers <br />Address: <br />25026 Rd 19 <br />Rocky Ford, CO 81067 <br />Phone Number: <br />(719) 254-3210 <br />Fax Number: <br />Email Address: <br />Caldwellcpa@yahoo.com <br />Permitting Contact: <br />Wayne Caldwell <br />Company: <br />Caldwell Brothers <br />Address: <br />2t375 -91 <br />Phone Number: <br />(�-19?071T <br />7�j zf -- <br />'7 <br />Fax Number: <br />Email Address: <br />C� we- Cp-� (v A <br />Inspection Contact: <br />Well <br />Ak- <br />,QG—/U N(S (fAl- ku1CFLz <br />Company: <br />Caldwell Brothers <br />Address: <br />263j 5- 1 <br />R c 7 <br />D5-0 -L (Z�L <br />floe (4-v <br />Phone Number: <br />9 <br />Fax Number: <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 />Signaturfof Permittee, Corporate Officer, Owner, or Documented Designee <br />M -AF -01 <br />Date <br />