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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 />Bill Kobobel <br />Permittee Company: <br />Bill Kobobel <br />Address: <br />7909 Weld County Road 5 <br />Longmont, CO 80504 <br />Phone Number: <br />(303) 591-0952 <br />Fax Number: <br />171;17324( <br />75l/ry,fpf a ' <br />, a' <br />(c. Ie <br />, <br />,,¢ <br />,.200Z - <br />Email Address: <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 />