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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: Sandra K.McDonald <br /> Permittee Company: City of Arvada <br /> C, /_ <br /> y <br /> Address: 8101 Ralston Rd r/6/ <br /> Arvada, CO 80001 /9/2-1/I,W 60 yam <br /> Phone Number: (720) 898-7811 <br /> 7 2-‘' Y7 2772- <br /> Fax Number: (720) 898-7603 <br /> 7 24, 85 S7 A,a- <br /> Email Address: Smcdonald@arvada.org <br /> �j4J�Lf/1- 41A. z �/LG <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 /> Y//0 4 <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br /> t'1Tti OF <br /> ARVADA Y OF <br /> PETE ADLER, PWLF <br /> UTILITIES PROJECT MANAGER PETE ADLER, PWLF <br /> PHONE:720-898-7782 ♦ CELL:303-349-3394 UTILITIES PROJECT MANAGER <br /> FAX:720-898-7603 PHONE:720-898-7782 ♦ CELL:303-349-3394 <br /> padler(a ar ada.org ♦ www anada org FAX:720-898-7603 <br /> 8101 RALSTON ROAD A ARVADA.CO 80002 padlerrg art ada org ♦ www arvada org <br /> 8101 RALSTON ROAD ♦ ARVADA,CO 80002 <br />