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Page 5 of5 <br /> Division records indicate the followingpermitteei1andowner 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: ' NlikeHorner , 5746411-777 <br /> Permittee Company: San Miguel County r_. <br /> Address: P.O. Box 426 <br /> Norwood, CO 81423 <br /> Phone Number: (970)327-4835 <br /> Fax Number: (970)327-4090 <br /> Email Address: <br /> ryarie-es mi_904(CotAtrly�9or <br /> Permitting Contact: Mike HornertZ`l1/4ry ,ZlL fiern <br /> Company: San Miguel County <br /> Address: P.O. Box 426 <br /> Norwood,CO 81423 <br /> Phone Number: (970)327-4835 <br /> Fax Number: (970)327-4090 <br /> Email Address: <br /> Inspection Contact: Mike Homer Zt 6 4'F791 <br /> Company: San Miguel County <br /> Address: P.O. Box 426 <br /> Norwood,CO 81423 <br /> Phone Number: (970)327-4835 <br /> Fax Number: (970)327-4090 <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 conducted in accordance with the Division approved mining and reclamation plans. <br /> e7 <br /> Signature o rmitt�'or•orate Officer,Owner,or Documented Designee Da <br /> M-AF-04 <br />