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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: Jerry Carpenter <br /> Permittee Company: Grand Gravel Pit, LLC <br /> Address: 2 County Road 2 <br /> Kremmling, CO 80459 <br /> Phone Number: - 970 5.31 a 3 a 7 <br /> Fax Number: 4=4-724 S90-S <br /> Email Address: Badlandsbc@gmail.com s►`y I ckc f 6,y e..._ 6(n c,,, • C U Yyi <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 /> / ------------------- 5 - 5 -/G <br /> Signature o ermittee, Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />