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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 /> Permittee 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 (7/4) -74 3- :2 g l S- <br /> Email Address: Dnr-drmsminadrnin@stateXo.us <br /> C l aiU e L�hcoln c •�� G®. �� <br /> Permitting Contact: John DeWitt Tr-e, 3�(Pn-e,'S <br /> Company: Lincoln County <br /> G.�n�1�t �- <br /> Address: P.O. Box 39 RO Sex 3q( <br /> Hugo, CO 80821 <br /> )4ug0, 60 07a g� � <br /> Phone Number: (719)743-2337 <br /> Fax Number: (719)743-2815 (71q) <br /> Email Address: <br /> Inspection Contact: John DeWitt <br /> fire S�v�rc-s <br /> Company: Lincoln County <br /> Address: P. O. Box 39 D glX <br /> Hugo, CO 80821 <br /> Phone Number: (719)743-2337 L7 i 7 .2 3 <br /> Fax Number: (719)743-2815 C7 R) -7 4f 3- Z g <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 /> Signat a of P tee Cor orate Officer,Owner,or Documented Desisnee Date <br /> M-AF-04 <br />