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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: Dennis Sanchez <br /> Permittee Company: Colorado Department of <br /> Transportation <br /> Address: 260 Ranney St. <br /> Craig,CO 81625 <br /> Phone Number: (970)824-5104 <br /> Fax Number: (970)826-5213 L <br /> Email Address: Dennis.sanchez@state.co.us <br /> Permitting Contact: Rex Goodrich <br /> Company: Colorado Department of <br /> Transportation <br /> Address: 222 S 6th St Rm 317 (, �r <br /> Grand Junction, CO 81501- <br /> 2769 <br /> Phone Number: (970)248-7228 <br /> Fax Number: (970)248-7254 (Oo <br /> Email Address: <br /> Inspection Contact: Rex Goodrich <br /> Company: Colorado Department of <br /> Transportation <br /> Address: 222 S 6th St Rm 317 C <br /> C v1�k .� <br /> Grand Junction, CO 81501 <br /> C_ Q' <br /> Phone Number: (970)248-7228 <br /> Fax Number: <br /> Email Address: `✓ <br /> �.vtC�,Z�`'� `J�LtQ.,tom'. l' <br /> 1,the undersigned,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> being co%ucted in accordance with the Division approved mining and reclamation plans. <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />