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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: Jeffrey D.Coonts <br /> Trve� �arneS <br /> Permittee Company: Lincoln County <br /> L- `0 <br /> Address: P.O. Box 39 P© 9 <br /> Hugo, CO 80821 <br /> H1,(g 0 <br /> Phone Number: (719)743-2337 Oi q) <br /> Fax Number: (719)743-2815 -?Iq) 7 q 3 _ 2 S ) 5— <br /> Email Address: Dnr—drmsminadmin@state.co.us Z r-ian 1 u�� l(� �G©� GB- it s <br /> Permitting Contact: John DeWitt <br /> Company: Lincoln County <br /> �f- <br /> Address: P.O. Box 39 <br /> Hugo, CO 80821 P <br /> Phone Number: (719)743-2337 (71q) 7 q _ 3 3 7 <br /> Fax Number: (719)743-2815 <br /> Email Address: <br /> C�I�h�u s e (9pL <br /> Inspection Contact: John DeWitt <br /> Sdrme S <br /> Company: Lincoln County <br /> Address: P.O. Box 39 <br /> Hugo, CO 80821 <br /> Phone Number: (719)743-2337 <br /> Fax Number: (719)743-2815 G?f 17/ <br /> Email Address: &--l-41ill-c.s 2 L;nce��,Gpu�f CB, �t <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 /> Signatu a of P mittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />