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w <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: Dale Trowbridge <br /> Permittee Company: The New Cache La Poudre <br /> Irrigating Company <br /> Address: 33040 Railroad Ave <br /> Lucerne,CO 80646 <br /> Phone Number: (970)352-0222 <br /> Fax Number: (970)352-0226 <br /> Email Address: Dale@newcache.com <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 /> h4k S hx) h <br /> Signature of Permittee.Corporate Officer,O er,or Documented Designee D to <br /> M-AF-01 <br />