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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 />-ei 3es <br />New C.5.4 `. ; Fri ll eIco- k <br />Permittee Company: <br />Grand County <br />Address: <br />P.O. Box 9 <br />Granby, CO 80446 <br />Phone Number: <br />(970) 887-2123 <br />Fax Number: <br />(970) 887-3168 <br />Email Address: <br />be +ar k G cA g J -C-► <br />• do • <br />S <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 />)d <br />7- 9-20%6 <br />Signature o/Permittee, Corporate Officer, Owner, or Documented Designee Date <br />M -AF -04 <br />