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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 />Gregory E. Gulley <br />Q ,cvn P. s*\** ix <br />Permittee Company: <br />Denver Water Department <br />Ti)en1/4.)-e r L ) alceir b -e P-av kmen \- <br />Address: <br />1600 W. 12th Avenue <br />Mail Code 500 <br />Denver, CO 80204 <br />X00 ls� • Ztt- �� t,,,e <br />l'Aa\ Co & 4%3 <br />Oey1J`tr co 00109 <br />Phone Number: <br />(303) 628-6309 <br />�U3) (oZB'%S3q ) <br />( <br />Fax Number: <br />(303) 628-6851 <br />( 5) )Z8— gS—Z <br />Email Address: <br />Greg.gulley@denverwater.org <br />. st; 4-k e 12v»•e it W AA- e r •afa) <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 />12z I I ( <br />Signa`ermiorporate Officer, Owner, or Documented Designee Date <br />M -AF -01 <br />