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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: Bid-4ar-k- <br /> Linda DeRose <br /> Permittee Company: Moffat County <br /> Moffat County Road & Bridge <br /> Address: P.O.Box 667 <br /> PO Box 667 <br /> Craig,Co 81626 Craig, CO 81626 <br /> Phone Number: (970)824-3211 <br /> 970-824-3211 Ext 1014 <br /> Fax Number: (970)824-0356 <br /> 970-824-0356 <br /> Email Address: Iderose@moffatcounty.net <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 /> 4 Z& zei zj: lY�, 09/13/2016 <br /> g ature of Permittee,Corporate Officer,Owner,o _ ocumented Designee Date <br /> M-AF-04 <br />