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Page 5 of 6 <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: Ward Priestley <br /> Permittee Company: Hank Williams, Inc. dba <br /> Williams Construction <br /> Contractors <br /> Address: P O Box 704 <br /> Norwood, CO 81423 <br /> Phone Number: (970) 327-4218 <br /> Fax Number: (970) 327-4157 <br /> Email Address: Ward@williamsconstruction.biz <br /> Permitting Contact: Ward Priestley <br /> Company: Hank WIlliams, Inc dba <br /> Williams Construction <br /> Contractors <br /> Address: P O Box 704 <br /> Norwood, CO 81423 <br /> Phone Number: (970) 327-4218 <br /> Fax Number: (q 76)32 7 --F/5 7 <br /> Email Address: Ward@williamsconstruction.biz <br /> Inspection Contact: Ward Priestley <br /> Company: Hank WIlliams, Inc dba <br /> Williams Construction <br /> Contractors <br /> Address: P O Box 704 <br /> Norwood, CO 81423 <br /> Phone Number: (970) 327-4218 <br /> Fax Number: (I76, -127-4/s3 <br /> Email Address: Ward@williamsconstruction.biz <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 the Division approved mining and reclamation plans. <br /> /17-7--/p <br /> Signature of Permittee.Corporate Officer,Owner,or Documented Designee Date <br />