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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: <br /> Dan Miller <br /> Permittee Company: Moffat County <br /> Address: P.O.Box 667 <br /> Craig,Co 81626 <br /> Phone Number: (970)824-3211 <br /> Fax Number: (970)824-0356 <br /> Email Address: dmiller@moffatcounty.net <br /> Permitting Contact: Ma.. <br /> Dan Miller <br /> Company: <br /> Moffat County Road Dept <br /> Address: P.O. Box 667 <br /> 0_e:6, 00 01G8S Craig, CO 81626 <br /> Phone Number: (970)021 9299 <br /> 970-824-3211 Ext 1015 <br /> Fax Number: <br /> 970-824-4347 <br /> Email Address: <br /> dmiller@moffatcounty.net <br /> Inspection Contact: Billy Maok <br /> Dan Miller <br /> Company: Moffat County Road Department <br /> Address: P.O.Box 667 <br /> Craig,CO 81626 <br /> Phone Number: (970)824-3211 <br /> Fax Number: (970)824-0356 <br /> Email Address: <br /> dmiller@moffatcounty.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 /> 09/19/2017 <br /> Signature of Permittee,Corp ate Officer,Owner,or Documented Designee Date <br /> M AF-04 <br />