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Page 5 of S <br /> Division i£iia [Ia1'ia.L tir fnI..W:L,p i1i“U--Il w.easu.w.Rr iv .,..t HIfo_ :rs:I J.:{nILH l:l3Har snaH;%.at H,IU,.s�rc caes.s ini.e s..rc <br /> information on record). If this information is blank or not current,please type or print current contact information: <br /> liftrailtbetrasiont i Ranh,Sai i <br /> Permittee Company: Tllps Geey <br /> Address: 221 S. Interocean Ave. <br /> Holyoke,CO 80734 <br /> Phone Number: (970) 854-3778 <br /> Fax Number: (970)854-3811 <br /> Email Address: Randy.schafer@phillipscounty.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: <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: ?i,a •g5-i- s // <br /> Email Address: rQnt&, s,?{' pk/4�Se_iiGr4' e,G <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 /> 'A ///o2G / -7 <br /> Signature of PerC)-ietric,), <br /> ee,Corp 1, ate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />