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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: Russell A.Larsen <br /> Permittee Company: Grand Junction Pipe&Supply <br /> Co. <br /> Address: 556 Struthers Ave. <br /> Grand Junction, CO 81501- <br /> 2826 <br /> Phone Number: (970)242-5370 <br /> Fax Number: (970)245-7716 <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 condu in accordance h the 'vision approved mining and reclamation plans. <br /> o" i�O <br /> Signature of Per Ittee,Cor ,orat Offic ,Owner,or Documented Designee Date <br /> M-AF-01 <br />