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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: Marcy Brossman <br /> Permittee Company: Cheyenne County <br /> Address: P.O.Box 567 <br /> Cheyenne Wells, CO 80810 <br /> Phone Number: (719)767-5872 <br /> Fax Number: (719)767-5753 / <br /> ccadmin@rebeltec.net r/ <br /> Email Address: Ccadmin@rebeltec.rret <br /> Marcy Brossman <br /> Permitting Contact: Lara Crowell <br /> Company: Cheyenne County <br /> Address: P.O.Box 567 <br /> Cheyenne Wells,CO 80810 <br /> Phone Number: (719)767-5872 <br /> Fax Number: (719)767-5540 719-767-5753 <br /> Email Address: ccadmin@rebeltec.net <br /> Inspection Contact: Carl Randel <br /> Victor Gibbs <br /> Company: Cheyenne County <br /> Address: P.O. Box 567 <br /> Cheyenne Wells,CO 80810 <br /> Phone Number: (719) 962-3270 _ <br /> Fax Number: (719)767-5753 <br /> Email Address: ccadmin@rebeltec.net <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 /> I&V County Administrator 8/31/2017 <br /> - I I AA-L,-Ae" <br /> Signa re of Permittee,Corporate Officer,Owner,or Documented Desk Date <br /> AS•AF44 <br />