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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: <br />Ken Coulson <br />Permittee Company: <br />Coulson Excavating Company, <br />Inc. <br />Address: <br />3609 North County Road 13 <br />Loveland, CO 80538 <br />Phone Number: <br />(970) 667-2178 <br />Fax Number: <br />(970) 667-2193 <br />Email Address: <br />Sandy@coulsonex.com <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 />I <br />'L;J% <br />( <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee <br />/1 <br />Date <br />