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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: d. <br /> m► LLSS S jLOc 7- <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: <br /> 9)o-52,-z►I e 951 - 36o-536o goo-zza-5360 <br /> Fax Number: <br /> `'5.1-6$y-l6 -f <br /> Email Address: <br /> /V2 i L S, (LO ffIik rQ.S!L Acro A•.eO riA <br /> I,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are <br /> being conducted i cc rdaj$e ; i ision approved mining and reclamation plans. <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-O I <br />