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Pale 3 oil <br /> ds Indicate t.%1kn%aRg peru'..,ecllando•.vner CIfltact iRzio.nt�'.,.oz,.R— ...,id.,Got�,-- <br /> information on record). If this information is blank or not current,please type or pent co rrrat contact informatiim: <br /> 1?ermigherist t 7R63b0nim <br /> 1Tami>xoeC.on�� �i�Cs■ia�' <br /> � 1 <br /> Address: 315 Main St., Ste.2 <br /> Sterling,CO 80751 <br /> Phone Number: (970)522-7879 <br /> Fax Number: (970)522-4018 <br /> Email Address: Quintr@logancountyco.gov <br /> Permitting Contact: Rob Quint <br /> Company: Logan County <br /> Address: 315 Main St., Ste. 2 <br /> Sterling, CO 80751 <br /> Phone Number: (970) 522-7879 <br /> Fax Number: (970)522-4018 <br /> Email Address: <br /> Inspection Contact: Chad Wright <br /> Company: Logan County <br /> Address: 12603 CR 33 <br /> Sterling, CO 80751 <br /> Phone Number: (970)522-3426 <br /> Fax Number: (970)522-4018 <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 condu i cordance with the Division approved mining and reclamation plans. <br /> Signa re of Permittee,Corporate Officer,Owner,or Documented Designee Da e <br /> M-AF-04 <br />