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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 /> /71 13atu- C V19 1,9 <br /> Permittee Company: Grand County <br /> Address: P.O. Box 9 <br /> Granby, CO 80446 <br /> Phone Number: (970)887-2123 <br /> Fax Number: (970) 887-3168 <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 /> az.-6� ,&— t/ 7 /(a <br /> Signatur of-Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />