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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: James Simpson <br /> Permittee Company: Arnolds Custom Seeding,LLC <br /> Address: 4626 WCR 65 <br /> Keenesburg,CO 80643 <br /> Phone Number: (303)710-0476 <br /> Fax Number: (303)732-0510 <br /> Email Address: Slicer@acsseeding.com <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 /> 5/9/4 <br /> Si onure of 1 "ee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />