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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: Nathan Mosely <br /> Permittee Company: Adams County <br /> Address: 9755 Henderson Rd <br /> Brighton, CO 80601 <br /> Phone Number: (303) 637-8006 <br /> Fax Number: (303)637-8015 <br /> Email Address: Nmosely@adcogov.org <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 /> Signature of P ittee Cor orate Offi , Owner,or Documented Designee Date <br /> M-AF-01 <br />