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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: Paula Weeks <br /> Permittee Company: Kit Carson County <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: RiG�G'a U� Wd <br /> U <br /> Company: Kit Carson County <br /> Address: P.O. Box 249 <br /> Burlington, CO 80807 <br /> Phone Number: (719)346-8133 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Riek-� <br /> D,4v� <br /> Company: Kit Carson County <br /> Address: P.O. Box 249 <br /> Burlington, CO 80807 <br /> Phone Number: (719)346-8133 <br /> Fax Number: <br /> Email Address: <br /> 1,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 /> � �21^J7 <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />