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Page 5 of 5 <br /> Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have <br /> information on record). If this information is blank or not current,please type or print current contact information: <br /> Permittee Contact: Robin Varelman <br /> Permittee Company: 5A Aggregate LLC <br /> Address: 31015 County Road K <br /> Brush, CO 80723 <br /> Phone Number: (970) 380-3798 <br /> Fax Number: <br /> Email Address: Rlsage65@hotmail.com <br /> Permitting Contact: Robin Varelman <br /> Company: 5A Aggregates LLC <br /> Address: 31015 County Road K <br /> Brush, CO 80723 <br /> Phone Number: (970) 380-3798 <br /> Fax Number: <br /> Email Address: Rlsage65@hotmail.com <br /> Inspection Contact: Robin Varelman <br /> Company: 5A Aggregate LLC <br /> Address: 31015 County Road K <br /> Brush, CO 80723 <br /> Phone Number: (970)380-3798 <br /> Fax Number: <br /> Email Address: Rlsage65@hotmail.com <br /> I,t ersigned, hereby state that the information provided in this report is true and accurate, and that site operations are <br /> mg onducte in accord ce with the Division approved mining and reclamation plans. <br /> / 0? <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />