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Page 5 of 4 <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: Wilma Erven —�—� <br /> Permittee Company: City of Delta _1 J <br /> Address: 360 Main Street <br /> Delta, CO 81416 <br /> Phone Number: (970) 874-7566 <br /> Fax Number: <br /> 970 - 874 - I .353 <br /> Email Address: -ro o "I ne+ <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 /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />