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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: Carolyn Tice 11 "L EA.) <br /> Permittee Company: City of Walsenburg <br /> Address: 525 S Albert <br /> Walsenburg,CO 81089 <br /> Phone Number: (719)738-1048 <br /> Fax Number: (719)738-1875 <br /> Email Address: Djohnston@cityofwalsenburg.com � e6-)" � Uj. Lis I y. C <br /> ool <br /> Permitting Contact: Buck Barnhart �f�l <br /> Company: Barnhart Agency, Inc. <br /> Address: 212 W. 13th Street <br /> Pueblo,CO 81003 <br /> Phone Number: (719)543-1324 <br /> Fax Number: (719) 543-1329 <br /> Email Address: <br /> Inspection Contact: Hank Summers <br /> Dfid; gw,7,-, <br /> Company: City of Walsenburg <br /> Address: 525 S Albert <br /> Walsenburg,CO 81089 <br /> Phone Number: (719)738-1048 <br /> Fax Number: (719)738-1875 <br /> Email Address: , )fr �^J g c-ri <br /> I,the undersigned,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> are <br /> being conducted in accord e with the Division approved mining and reclamation plans. <br /> 010 7 <br /> Signa re o Perm tee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />