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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: Chad Linker <br /> Permittee Company: Northern Colorado Constructors <br /> Address: 9075 Weld County Road 10 <br /> Fort Lupton,CO 80621 <br /> Phone Number: (303)857-1754 <br /> Fax Number: <br /> Email Address: Cpl@ncconstructors.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 /> Cki-11 13I-1zl1c <br /> Signature of Permittee,Cornorate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />