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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: Chris Zadel <br /> Permittee Company: Northern Colorado Constructors, <br /> Inc. Aggregate Div <br /> Address: 9075 WCR 10 <br /> Fort Lupton, CO 80621 <br /> Phone Number: (303)857-1754 <br /> Fax Number: (303)857-2933 <br /> Email Address: <br /> Permitting Contact: Ken Rollin <br /> Company: Rollin Consulting <br /> � �T Cor4sv l�-in <br /> Address: 840 Eagle Dr. <br /> 30S �ta�Jv- �{vc.nJL <br /> Eaton, CO 80615-9086 S uO D <br /> Phone Number: (970)454-0404 <br /> $S 6222. <br /> Fax Number: (970)454-2847 <br /> 303 — 8 622y <br /> Email Address: ` o K <br /> l� Y �J--t-co�ns �-�;h co►r. <br /> Inspection Contact: Chris Zadel <br /> Company: Northern Colorado Constructors, <br /> Inc. Aggregate Div <br /> Address: 9075 WCR 10 <br /> Ft. Lupton, CO 80621 <br /> Phone Number: (970) 587-4394 <br /> Fax Number: (970)587-4397 <br /> Email Address: <br /> C�c�S'Ly (�f�L�ov�S}c�c-F-orS. Go w% <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 /> Signature of Permit ee.Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />