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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: 4im Sheridan--- <br /> Scott Pottorff <br /> Permittee Company: Cotter Corporation <br /> Address: P.O. Box 700 <br /> Nucla, CO 81424 <br /> Phone Number: - r"' 970-773-4167 <br /> Fax Number: (970)864-7287 <br /> Email Address: dana.cline@cotterusa.com <br /> Permitting Contact: Gus Gavi oti s <br /> Company: Cotter Corporation <br /> Address: 7800 E. Dorado Place Suite 210 <br /> Englewood, CO 80111 <br /> Phone Number: (720) 554-6200 <br /> Fax Number: (720) 554-6201 <br /> Email Address: <br /> gus.gaviotis@cotterusa.com <br /> Inspection Contact: Rill WaRtag <br /> Scott Pottorff <br /> Company: Cotter Corporation <br /> Address: PO Box 700 <br /> ed' 'Q 4Q " -- Nucla, CO 81424 ✓ <br /> Phone Number: <br /> 970-773-4161 ✓ <br /> Fax Number: <br /> Email Address: dana.cline@cotterusa.com <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 /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-02 <br />