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JUL-23-2015 13:03 FROM:ENG <br />18778510015 TO:13038328106 <br />P.6/9 <br />Pago 5 of S <br />Division records indicate the following pernxittce contact information. if this information is not current, please type or <br />print current contact information: <br />Permittee Contact: 1imStruble <br />Permittee Company: <br />Address: <br />Phone Number: <br />Fax Number, <br />Email Address: <br />N Colo Water Cons, <br />220 Water Avenue <br />Berthoud, C040513 <br />(970)532-7700 <br />(970) 532-0942 <br />Dist. <br />a?o • �ZZ • Z <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 />or <br />Alft1 <br />MMTZr or to Officer, g&_ Der, or Documented Designee Date <br />M-AF4i <br />