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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: Bill Hudick <br /> Permittee Company: Hudick Excavating, Inc. <br /> Address: 160 County Rd 118 <br /> Franktown, CO 80116 <br /> Phone Number: (303)204-1431 <br /> Fax Number: 003)681:a3.1.4. .,303 U88. J108 <br /> Email Address: W.hudrick@hotmail.com J <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 e Division approved mining and reclamation plans. <br /> i0 5 <br /> Signature of ermittee,Corporate Officer,Owner,or Documented Designee Da e <br /> M-AF-04 <br />