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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: Dan or Doug Grant <br /> Permittee Company: Grant Bros Construction Ltd <br /> Address: P.O. Box 1027 <br /> Basalt, CO 81621 <br /> Phone Number: (970) 927-3201 <br /> Fax Number: (970) 927-8386 <br /> Email Address: <br /> 1,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are <br /> b ng con ucted in accordance with the Division approved mining and reclamation plans. <br /> Signature of Permittee, Corporate Officer, Owner,or Documented Designee D e <br /> M-AF-01 <br />