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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 <br /> Trey Se:ove <br /> Permittee Company: Lincoln County <br /> Address: P.O. Box 39 <br /> Hugo, CO 80821 <br /> Phone Number: (719)743-2337 <br /> Fax Number: (719)743-2815 <br /> Email Address: Dnr_drmsminadmin@state.co.us LG l ase ?J` t ce:u <br /> l'� L .h�olh� y s <br /> Permitting Contact: Jeff Coonts <br /> Company: Lincoln County <br /> Address: 103 3rd Avenue <br /> Hugo, CO 80821 <br /> Phone Number: (719)743-2337 <br /> Fax Number: <br /> Email Address: Lclanduse@lincolncountyco.us <br /> Inspection Contact: Jeff Coonts 1—re V Set rn,e S <br /> Company: Lincoln County <br /> Address: 103 3rd Avenue <br /> Hugo,CO 80821 <br /> Phone Number: (719)743-2337 <br /> Fax Number: <br /> Email Address: Lclanduse@lincolncountyco.us <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 /> j1 _ 1I-3-1 7 <br /> Signat of ittee Cor'orate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />