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• <br /> 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: Randy Renquist <br /> Permittee Company: Sedgwick County <br /> Address: 223 S Cedar <br /> Julesburg, CO 80737 <br /> Phone Number: (970)474-3576 <br /> Fax Number: (970)474-3558 <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 /> 41C, -0c/C <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />