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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: Craig Tessmer 1 enn i, Q. -4e r• <br /> Permittee Company: Adams County d,CUYIS CaNv-y <br /> Address: 4430 S.Adams County Parkway, 3r S.AdaJV r pvt...vval <br /> st Floor Q <br /> tsE Floor <br /> Brighton,CO 80601 10 ON.e01 <br /> Phone Number: (720)523-6841 Ci aj-) Sal -C23,141 <br /> Fax Number: (720)523-6498 C-�a o )S a3- LoIcts <br /> Email Address: Q ad L; ;OV <br /> leU 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 /> 11:14,eeti <br /> Signature of Permittee,Corporate Officer,Owner,or Documented €siznee Date <br /> M-AFA4 <br /> 1 <br />