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Page 6 of 6 <br /> 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: Roger L. Day <br /> Permittee Company: American Shale Oil, LLC <br /> Address: P. O.Box 1470 <br /> Rifle, CO 81650 <br /> Phone Number: (970) 625-4324 <br /> Fax Number: (970) 625-4318 <br /> Email Address: Rday@amso.net 1 $VJ i Z E ' ' CY. t7 iYl SC•n E a J it)a C � <br /> 0 Q It)so o F l <br /> Landowner Contact: B L M <br /> &+i-n K e ti+ W a l f- r <br /> Landowner Address. 220 M o Ir-ef 5fr of <br /> Mee kerY CO 8 l 641 <br /> Landowner Phone <br /> Number: <br /> Landowner Email <br /> I,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are <br /> being cond cted in accordance with the Division approved NOI and reclamation plans. Rule 5.6.1(h). <br /> '4 �'- .^vL��d'L /� z <br /> Signat of Permittee, orporate Officer,Owner,or Documented Designee Me <br /> P-AF-01 <br />