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ti 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: Robin Varelman <br /> Permittee Company: 5A Aggregate LLC <br /> Address: 31015 County Road K <br /> Brush,CO 80723 <br /> Phone Number: (970) 380-3798 <br /> Fax Number: <br /> Email Address: Rlsage65@hotmail.com <br /> I,the undersigned,hereby state that the information provided in this report is true and acc ate, and that site operations are <br /> rbei ,2cted in accordance with the Division approved mining and reclamation plans. <br /> Signat re of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br /> i <br />