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Iq7'7 1113 <br />Page 5 of 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 />Joseph, (Joby) B. Venuti <br />Permittee Company: <br />Ace West Trucking, Inc. <br />Address: <br />P 0 Box 117 <br />Rangely, CO 81648 <br />1659 A1. gc., Pk W. <br />5r rl (AGM , IY1 8'1165 <br />Phone Number: <br />(970) 675-2753 <br />-6.3Z w 562 <br />1 <br />Fax Number: <br />(970) 675-2702 <br />!OM L GvfrY,n4" 11 wiG <br />� <br />Email Address: <br />Joby@acewesttrucking.com <br />\a* e. ►'kkukt1, • COvh <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 , . ccordan - ith the Division approved mining and reclamation plans. <br />Signat e of ' ermittee <br />M•AF-0l <br />(r,51 i 7► kyr zit. if -2z- /5 <br />orate Officer, Owner, or'bocumented Designee Date <br />NOV 3 0 2015 <br />DIVISION OF RECLAMATION <br />MINING AND SAFETY <br />