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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 Reeder Ke,ki tas5eximpA\ <br /> Permittee Company: City of Boulder <br /> CA1o &Wei( <br /> Address: P.O. Box 791 ?,o <br /> Boulder,CO 80306 741, <br /> 5ookae 1, Co tv3th <br /> Phone Number: (303)413-7640 ( 7 20) 5(,K- ;2.0(04 <br /> Fax Number: (303)413-7617 COO <br /> 3) 13 _ '1 (QI <br /> Email Address: Reederj@bouldercolorado.gov Ock-neAaRJA\ebo.Actercolordelo. Q ov <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 /> 17:04- 71(4-r)-- 6/10/AD <br /> g <br /> Si nat of Permittee,Corporate Officer,Owner,or Documented Designee Dat <br /> M-AF-04 <br />