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Paae 5 of 5 <br /> Division records indicate the following permittee contact information. If this infomtation is not current,please type or print <br /> current contact information: <br /> IPermittee Contact: James MacDonald <br /> Permittee Company: APC Southern Construction Co., <br /> LLC <br /> Address: 14802 lV 44th Avenue <br /> Golden,CO 80403 <br /> Phone Number: (303)279-6611 <br /> Fax Number: (303)279-6216 <br /> Email Address: st3/140-c ia@ /1PCS4.,,A Co 10--7 <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 /> ae.f. <br /> Si k nature of ' rmittee,Corpo ate Officer,Owner,or Documented Designee Date <br /> .. Ar <br />