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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: Siwe l e1ly' <br /> DriVi1� MRI <br /> Permittee Company: Lawrence Construction <br /> Company, Inc. <br /> Address: 9002 N Moore Road <br /> Littleton,CO 80125 <br /> Phone Number: (303)791-5642 <br /> Fax Number: (303)791-5647 <br /> Email Address: Ukelley@a lawrenee- DM 6R/215c. La W Rit,icE_canll/Rv c71 o,J. OQJ%\ <br /> csmstrnet : n- <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 /> t <br /> .363 — 1 3� <br />