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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 -re, :S�t <br /> Permittee Company: Lincoln County !—hP1 GO I/'' (!/ 0a r)l' <br /> Address: P.O. Box 39 p 0 80k 31 <br /> Hugo, CO 80821 <br /> Phone Number: (719)743-2337 <br /> Fax Number: (719)743-2815 /,7) --7 3 a r <br /> Email Address: Dnr-drmsminadmin@state.co.us (�LIQn�lc5�i�Li/ j»lpcc»� GO u s <br /> Permitting Contact: John DeWitt <br /> Company: Lincoln County <br /> Li�G®/� �ou•,f <br /> Address: P.O. Box 39 P © RoA- 31 <br /> Hugo, CO 80821 <br /> Phone Number: (719)743-2337 <br /> (70) -743--a2 -�37 <br /> Fax Number: (719)743-2815 <br /> Email Address: // <br /> ZL Jdlhdllk 5 e 6V l;n Lolr► G1vt y c®,u s <br /> Inspection Contact: John DeWitt y-- <br /> Company: Lincoln County <br /> L;ncpin <br /> Address: P.O. Box 39 P 61 B )t <br /> Hugo,CO 80821 <br /> 60 <br /> Phone Number: (719)743-2337 / '� 3 3 <br /> Fax Number: (719)743-2815 �. 700 f) <br /> Email Address: Ge- <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 /> 9- 7- <br /> Signatu of Per ee Cor orate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />