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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: Bill Hudick <br /> Pernittee Company: Hudick Excavating,Inc. <br /> Address: 160 County Rd 118 <br /> Franktown, CO 80116 <br /> Phone Number: (303) 204-1431 <br /> Fax Number: (303) 688-7314 <br /> Email Address: max,7 L—J-i k@hotmail.com <br /> (i I)rGK C Wrna►t l.Gbrn <br /> 1, 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 /> _it)z <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />