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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: Christie Coleman Anastasia Frantsova <br /> Permittee Company: City of Greeley <br /> Address: 1100 10th Street, Suite 300 <br /> Greeley,CO 80631 <br /> Phone Number: (970)336-4039 (970) 350-9806 <br /> Fax Number: (970)350-9805 <br /> Email Address: <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 /> r i ✓Q.odi GZ 6/e/L 0/6 <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M•AF-04 <br />