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Page 5 01*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 />RussellA. Larsen <br />Permittee Company: <br />Elam Construction, Inc. <br />Address: <br />556 Struthers Ave <br />Grand Junction, 0081501 <br />Phone Number: <br />(970) 242-5370 <br />Fax Number: <br />(970) 245-7716 <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 i%accordance with the DiXion approved mining and reclamation plans. <br />L.— q� <br />Own er• or DQSumented Designee ate <br />M -AMI <br />