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Pagc 5 of 5 <br />Division records indicate the following permittee contact information. Willis information is not current, please type or print <br />currcnt contact information: <br />Permittee Contact: Bradley Dallam <br />Permittee Company: The City of Lafayette <br />Address: <br />1290 South Public Road <br />Lafayette, CO 80026-2706 <br />Phone Number: (303) 665-5588 <br />Fax Number: (303) 665-2153 <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 />y <br />/0/,3//- " <br />Signature of ' ermittee, or Officer, Owner, or Documented Desienee Da <br />M•Arw <br />