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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: Mark Dorenkamp <br /> Permittee Company: Prowers County <br /> Address: 109 E. Sherman St. <br /> Lamar, CO 81052 <br /> Phone Number: (719)336-5536 <br /> Fax Number: (719)336-9633 <br /> Email Address: <br /> Permitting C tact: D d Ko <br /> C6m Prowers County <br /> Address: 109 E. Sherman St. <br /> Lam <br /> Phone Number- 336- <br /> Fax er: <br /> Email Address: <br /> s ect' D <br /> an Prowers Coun <br /> Address: 109 E. Sherman St. <br /> amar,C <br /> P <br /> -------------------- <br /> Fax Number: <br /> Email Addres <br /> 1,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are <br /> being f*nduc�cd.in ac or, ce wit.4 the Division approved in reclamation plans. <br /> Signature of Permittee.Coru rate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />