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Page of 5 , <br />Division records indicate the following permittee contact information. If this information is not current, please type or <br />print current contact information: <br />Permittee Contact: <br />ChadLinker <br />Permittee Company: <br />Northern Colorado Constructors <br />Address: <br />9075 Weld County Road 10 <br />Fort Lupton, C080621 <br />Phone Number: <br />(303) 857-1754 <br />Fax Number: <br />Email Address: <br />Cpl@ncconstructors.com <br />I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operation are <br />being conducted in accordance with the Division approved mining and reclamation plans. <br />it n . — it <br />Signature <br />M -AF -01 <br />Owner. or Documented Designee <br />8 '4 1 IS <br />Date <br />