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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: <br /> M i LE S Srvev T- <br /> Permittee Company: Skanska USA Civil West Rocky <br /> Mountain District Inc. <br /> Address: 22419 CR G <br /> P.O. Box 1660 <br /> Cortez,CO 81321 <br /> Phone Number: (970)529-- -ZJ( <br /> Fax Number: (970)565-0188 <br /> Email Address: <br /> I,the undersigned, by s e that the information provided in this report is true and accurate,and that site operations are <br /> being conducted ' cord e h hP n.��:�.�n a proved mining and reclamation plans. <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Desisnee Date <br /> M-AF-01 <br />