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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: Aaron Bivens <br /> Permittee Company: Bivens Trucking&Excavating, <br /> Inc. <br /> Address: 862 W.Willox Ln <br /> Ft. Collins,CO 80524 <br /> Phone Number: (970)482-0358 <br /> Fax Number: (970)221-1626 <br /> Email Address: Bivensrecycling@yahoo.com <br /> 1,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 /> A,,, z . 2�:� �) - Ja -hs <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />