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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: Jennifer Rutter <br /> Permittee Company: Adams County <br /> Address: 4430 S. Adams County Parkway, <br /> 1 st Floor <br /> Brighton, CO 80601 <br /> Phone Number: (720)523-6841 <br /> Fax Number: (720) 523-6998 <br /> Email Address: Jrutter@adcogov.org <br /> Permitting Contact: Craig Tessmer <br /> Company: Adams County CCn Vital <br /> Address: 4430 S. Adams County Parkway, <br /> 1 st Floor <br /> Brighton, CO 80601 <br /> Phone Number: (720)523-6841 <br /> Fax Number: (720)523-6998 <br /> Email Address: GOA W 0 V, O <br /> Inspection Contact: Craig Tessmer <br /> Company: Adams County <br /> Address: 4430 S. Adams County Parkway, <br /> 1 st Floor <br /> Brighton, CO 80601 <br /> Phone Number: (720) 523-6841 <br /> Fax Number: (720) 523-6998 <br /> Email Address: <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 /> la lko <br /> Sig ure mitte Corporate Officer.Owner.or Documented Designee Date <br /> M-AF- <br />