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Division records indicate the following permittee/landowner contact information. If this information is not current, please <br />type or print current contact information: Rule 5.6.1(a, b). <br />Permittee Contact: <br />Mike Joosten <br />Permittee Company: <br />Mike Joosten <br />Address: <br />7775 E. 124th Dr. <br />Thornton, CO 80602 <br />Phone Number: <br />(720) 201-0258 <br />Fax Number: <br />Email Address: <br />Mike@joosten.us <br />Landowner Contact: <br />PA;V11 <br />Landowner Address: <br />'7 % -7 0 r- <br />-rtiOc rAJ n, Co g'O 6 a Q <br />Landowner Phone <br />Number: <br />Landowner Email <br />tM � ke LO aoos Leh . v S <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 NOI and reclamation plans. Rule 5.6.1(h). <br />Signature <br />P -AF -01 <br />� g lel <br />Owner, or Documented Designee Date <br />