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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: Ken Haynes <br /> Permittee Company: Grand County <br /> Address: P.O.Box 9 <br /> Granby, CO 80446 <br /> Phone Number: (970)887-2123 <br /> Fax Number: (970)887-3168 <br /> Email Address: Co �l C 0. (JS <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 /> �1) � Z 7 1 <br /> A A A -X9 - F <br /> Signature of Permittee, Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />