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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: Richard L.Wamsley <br /> Permittee Company: Richard L Wamsley dba-RLW <br /> Enterprises <br /> Address: 3465 County Road 11 <br /> Walden,CO 80430 <br /> Phone Number: (970)723-4353 <br /> Fax Number: (970)7234353 <br /> Email Address: <br /> W-s^ filly b Wll/ <br /> Permitting Contact: Richard L amsley <br /> Company: Richard L Wamsley dba-RLW <br /> Enterprises <br /> Address: 3465 County Road 11 <br /> Walden, CO 80430 <br /> Phone Number: (970)723-4353 <br /> Fax Number: (970)7234353 <br /> Email Address: <br /> Inspection Contact: Richard L. amsley <br /> Company: Richard L Wamsley dba-RLW <br /> Enterprises <br /> Address: 3465 County Road 11 <br /> Walden,CO 80430 <br /> Phone Number: (970)723-4353 <br /> Fax Number: (970)723-4353 <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 /> e6 3201y <br /> Signature of Permittee.Cora to Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />