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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: Juliet A. Moores <br /> Permittee Company: Elk Creek Sand& Gravel, LLC <br /> Address: P.O. Box 416 <br /> Conifer, CO 80433 <br /> Phone Number: (303) 816-4047 <br /> Fax Number: <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 /> being conducted in accordance with the Division approved mining and reclamation plans. <br /> Signature of Permittee, Corporate Officer, Owner,or Documented DesiLnee Date <br /> M-AF-0I <br />