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ITam�e'Ca�ta�t {�a$i� <br /> PernntteeCompany: latcar onComA0, <br /> Address: P.O.Box 160 <br /> Burlington, CO 80807 <br /> Phone Number: (719)346-8139 <br /> Fax Number: (719)346-7242 <br /> Email Address: <br /> Permitting Contact: Paula Weeks <br /> Company: Kit Carson County <br /> Address: County Administrator <br /> P.O. Box 160 <br /> Burlington, CO 80807 <br /> Phone Number: (719)346-8139 <br /> Fax Number: (719)346-7242 <br /> Email Address: <br /> Inspection Contact: <br /> �A-vr a)�A/u IYK <br /> Company: Kit Carson County <br /> Address: Road&Bridge Supervisor <br /> P.O. Box 160 <br /> Burlington, CO 80807 <br /> Phone Number: (719)349-1985 <br /> Fax Number: (719)346-7242 <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 /> lLO - 11 � 17 <br /> Signature of Permittee,Corporat cer,Owner,or Documented Designee Date <br /> M-AF-04 <br />