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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: Nick H. Gray <br /> Permittee Company: Nick H. Gray <br /> Address: 584 65.30 Rd. <br /> Montrose,CO 81401 <br /> Phone Number: (970)249-9436 <br /> Fax Number: (970)252-1265 <br /> Email Address: <br /> I,the undersigned,hereb : <br />