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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: Kevin Anderson <br /> Permittee Company: Connell Resources, Inc. <br /> Address: 7785 Highland Meadows Pkwy., <br /> Ste. 100 <br /> Fort Collins, CO 80528 <br /> Phone Number: (970)223-3151 <br /> Fax Number: (970)223-3191 <br /> Email Address: <br /> Permitting Contact: � A // <br /> Company: <br /> �U l4 C �aZ 7L4 Sd!ca. Y�o ../• <br /> Address: * 499--W i 29t A_._�+��_ <br /> r, r� ;' Po max 2 Y 2 7 <br /> Phone Number: <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: / <br /> d�r.r0s.. <br /> Company: Connell Resources, Inc. <br /> Address: 7785 Highland Meadows Pkwy., <br /> Ste. 100 <br /> Fort Collins, CO 80528-5000 <br /> Phone Number: (970)223-3151 <br /> Fax Number: (970)223-3191 <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 Designee Date <br /> M-AF-01 <br />