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�l <br /> 970 245 7716 Elam Construction Elam Construction 03:05:30 p.m. 08-25-2016 1 11 <br /> � 5 <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: Russell A.Larsen <br /> Permittee Company: Elam Construction, Inc. <br /> (/ Address: 556 Struthers Ave <br /> Grand Junction,CO 81501- <br /> 3826 <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 conducted in accordance with the Division approved mining and reclamation plans. <br /> Signatur Permittee Co orate Officer,Owner,or Documented Designee Date <br /> bf-at•oi <br /> REr. IVED <br /> AUG 25 2016 <br /> DIVISIQvi -,c-.y AMATION, <br /> MINING TY-MINERALS <br /> eo <br />