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Page 5 of 5 <br />Division records indicate the following permittee contact information. If this information is not current, please type or print <br />current contact information: <br />Permittee Contact: <br />Russell A. Larsen <br />Permittee Company: <br />Elam Construction, Inc. <br />Address: <br />556 Struthers Ave <br />Grand Junction, CO 81501- <br />3826 <br />Phone Number: <br />(970) 242-5370 <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 />Signa pre of Permittee, or or` ate Officer, Owner, or Documented Designee Date <br />M -AF -01 <br />