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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: LeRoy A.Bellmore <br /> Permittee Company: North Weld Gravel <br /> Address: 13480 Weld County Rd 100 <br /> Nunn, CO 80648-9700 <br /> Phone Number: (970) 897-2252 <br /> Fax Number: <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 /> Signature of Vermittee, Corporate 6fficer,Owner,or Documented Designee to <br /> M-AF-01 <br />