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Page 3 45 <br /> J ZiL,uJ-R,aR.Zii�-n1aL-�YG�V-[.m1iIIVt <br /> information on record). If this information is blank or not current,please type or print current contact information: <br /> Permittee Contact: Calvin Fr-k <br /> Permittee Company: Bent County <br /> Address: P.O. Box 350 <br /> Las Animas, CO 81054-0350 <br /> Phone Number: (719)456-2223 <br /> Fax Number: (719)456-0375 <br /> Email Address: Bent.admin@bentcounty.net <br /> Permitting Contact: rt� rynTr <br /> Company: Bent County <br /> Address: P.O. Box 350 <br /> Las Animas,CO 81054 <br /> Phone Number: (719)456-2223 <br /> Fax Number: -71 f— Yfd a37 - <br /> Email Address: �j�al� gj/Mry +e,�Jslv�cm+tri► ,yPZ` <br /> Inspection Contact: Robert Darnell <br /> Company: Bent County <br /> Address: P.O. Box 350 <br /> Las Animas,CO 81054 <br /> Phone Number: (719)456-2223 <br /> Fax Number: 7/9^yfd -03?yf <br /> Email Address: A/ , <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 /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />