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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: Matt Hansen <br /> Permittee Company: Sedgwick County <br /> Address: 223 S. Cedar <br /> Julesburg, CO 80737 <br /> Phone Number: (970)474-3576 <br /> Fax Number: (970)474-3558 <br /> Email Address: Dnr_drmsminadmin@state.co.us <br /> Permitting Contact: e ��l+ r1 4 Q s e pq <br /> Company: Sedgwick County l"l r� <br /> Address: 223 S Cedar <br /> Julesburg, CO 80737 <br /> Phone Number: (970)474-3576 <br /> Fax Number: (970)474-3558 <br /> Email Address: LV-DLc( V-I0�6 U9 mo- , G p/I,t <br /> Inspection Contact: SA* � j4I�� J� Q n 5 en <br /> Company: Sedgwick County ' I <br /> Address: 223 S Cedar <br /> Julesburg, CO 80737 <br /> Phone Number: (970)474-3576 <br /> Fax Number: (970)474-3558 <br /> Email Address: CJe—rp 4A b►'t-0-ae� pMQ i , e—oAi <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 /> 7 <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />