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f <br /> 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: Kane Schneider <br /> k(4.4.ti fcineAde te..L j <br /> /20 2)tviei, <br /> Permittee Company: Colorado Department of <br /> Transportation <br /> Address: 606 S. 9th St. <br /> Grand Junction,CO 81501 <br /> Phone Number: (970) 683-6300 <br /> Fax Number: (970)683-6340 <br /> Email Address: Kane.schneider@dot.state.co.us <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 /> N <br /> c. //t _ 1-2c0 -V,6 <br /> Signatur of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />