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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: Jewelie Yetter <br /> Permittee Company: R&J Yetter Sand&Gravel <br /> LLC <br /> Address: 16757 CR 16 <br /> Atwood, CO 80722 <br /> Phone Number: (970) 522-0867 <br /> Fax Number: �J <br /> ASS / <br /> Email Address: Yetterjewelie@yahoo.com , in , (/ <br /> ye- -cf3ewei qAhen.CO in <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 /> triA--) inarflaCip\ 5 -a--)6, <br /> Si ature of Per ee,Corporate Officer,()liner,or Documented Designee Date <br /> M-AF-O I <br />