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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: Randy Schafer <br /> Permittee Company: Phillips County <br /> Address: 221 S. Interocean Ave <br /> Holyoke,CO 80734 <br /> Phone Number: (970)854-3811 <br /> Fax Number: <br /> Email Address: Randy.schafer@phiIlipscounty.co <br /> Permitting Contact: Randy Schafer <br /> Company: Phillips County <br /> Address: 221 S. Interocean Ave <br /> Holyoke, CO 80734 <br /> Phone Number: (970)854-3778 <br /> Fax Number: <br /> Email Address: Randy.schafer@phillipscounty.co <br /> Inspection Contact: Randy Schafer <br /> Company: Phillips County <br /> Address: 221 S. Interocean Ave <br /> Holyoke,CO 80734 <br /> Phone Number: (970)854-3778 <br /> Fax Number: 97a - U5 _j&l <br /> Email Address: Randy.schafer@p/hillipscoounty.co <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 Permid4,Corpora Corporag Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br /> 7707� <br />