Laserfiche WebLink
Page 5 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 />GregoryLarson <br />Permittee Company: <br />Gregory Larson <br />Address: <br />14977 Co. Rd. 97 <br />Haxtun, C080731 <br />Phone Number: <br />(970) 580-3119 <br />Fax Number: <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 />Owner, or Documented Designee <br />M -A -01 <br />/,/- <br />Date <br />