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Page 5of5 <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: Melanie Bounds <br /> Permittee Company: Huerfano County <br /> Address: 401 Main St C. 105 CI 2-3 @-Rusf;c�L <br /> Wal urg, CO 81089 <br /> L)CVL(' \Dter CJ �i��V�I <br /> Phone Number: (-7-1-9-1-7-38-3.0.5-3- �" <br /> (g106113 - -3 a) M. \O.:5- <br /> Fax Number: <br /> Cry 1 ci> r13 -. -3u5_3 <br /> Email Address: Mbounds@huerfano.us <br /> Permitting Contact: Melanie Bounds <br /> Company: Huerfano County <br /> Address: 401 Main , e.105 ` I2 /��L -sL l <br /> n urg,CO 81089 <br /> LOASun <br /> / \ Ckl,�►� CO 0 IL8Ci <br /> Phone Number: --( 9)738-3053, C 1 + c\> ( i3 c C A I 0 <br /> Fax Number: 4719.,1_23.8.3-996- (fit COI(�. _ ��� <br /> Email Address: Mbounds@huerfano.us ) <br /> Inspection Contact: Drew Nigrini <br /> Ca-) ‘e______CC*i\--)c\...`_-) _ <br /> Company: Huerfano County <br /> Address: 401 Main St., /� <br /> Wals g,CO 81089 �� ' ' ` Lu-S>c -L <br /> Vc r-LAs-) eo 1 <br /> Phone Number: -{ 194-738-2370 <br /> (_(11C0 13 - 3c 0 0 Y 105 <br /> Fax Number: Cli c1\ 13 , a)5353 <br /> Email Address: ) I <br /> I,t e undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are <br /> bei conduted in acEordance with the Division approved mining and reclamation plans. <br /> o <<,,,: A- <br /> siI \- 2� -11 <br /> to of Permi ee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />