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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: <br />Billy E. Mack <br />Dan Miller <br />Permittee Company: <br />Moffat County <br />Address: <br />P.O. Box 667 <br />Craig, CO 81626 <br />Phone Number: <br />(970) 824-3211 <br />970 824-3211 Ext 1015 <br />Fax Number: • <br />970 824-0356 <br />Email Address: <br />Bmack@moffatcounty.net <br />dmiller@moffatcounty.net ✓ <br />Permitting Contact: <br />Marvin Moore <br />Linda DeRose <br />v <br />Company: <br />Moffat County Road & Bridge �( <br />Address: <br />1570 Ranney Street <br />Craig, CO 81625 <br />PO Bax 667 ✓ <br />Craig, CO 81626 <br />Phone Number: <br />(970) 824-9249 <br />970 824-3211 Ext 1014 <br />970-824-0356 <br />Iderose@moffatcounty.net <br />Fax Number: <br />Email Address: <br />Inspection Contact: <br />Billy Mack <br />Dan Miller <br />Company: <br />Moffat County Road Department <br />Address: <br />822 E. 1 st St. <br />Craig, CO 81626 <br />Phone Number: <br />(970) 824-3211 <br />Fax Number: <br />(970) 824-0356 <br />Email Address: <br />Bmack@moffatcounty.net <br />dmiller@moffatcounty.net <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 iryaccgrdance with the Division approved mining and reclamation plans. <br />01/06/2017 <br />Signature of Permittee. Corporate Officer, Owner, or Documented Designee Date <br />M -Ar -a <br />