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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: Richard Coulson <br /> Permittee Company: Coulson Excavating Company, <br /> Inc. <br /> Address: 3609 North County Road 13 <br /> Loveland, CO 80538 <br /> Phone Number: (970)667-2178 <br /> Fax Number: (970)667-2193 <br /> Email Address: Sandy@coulsonex.com <br /> I,the undersigned,hereby state that the' ormation provided in this report is true and accurate, and that site operations are <br /> being conducted in accordance wit e D 'sion appr9yed mini and reclamation plans. <br /> Signaturt of Permit or orate 1 er,Ow er,or Documented Designee Dat <br /> M-AF-01 <br />