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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: StaceYMzMMMkag <br /> Permittee Company: Mesa County <br /> Address: P.O. Box 20000-5025 <br /> Grand Junction,CO 81502 <br /> Phone Number: <br /> ��1�) Zyy -1FS`I5 <br /> Fax Number: <br /> Email Address: wS <br /> I,the undersigned,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> being ducted in accordance with the Division approved mining and reclamation plans. <br /> L �Ot' I d2� zLzi� <br /> Signature of P rmittee or orate Offi er,Owner,or cumented Designee ate <br /> M-AF-04 <br />