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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: U Quy <br /> DAvi b HoRR►O <br /> Permittee Company: Lawrence Construction <br /> Company, Inc. <br /> Address: 9002 N Moore Road <br /> Littleton,CO 80125 <br /> Phone Number: (303)791-5642 <br /> Fax Number: (303)791-5647 <br /> Email Address: LEI - Z)MOjR,3(-LQWRSNCF-CoriSTQVCTIo�, 0*11A <br /> 1,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 /> C1110f oA*1>JNC OMEN i 2? 7ro11 <br /> ignature of Permi ee,Corporate Officer,Owner,or Documented DesiSnee 16ate <br /> M-AF-01 <br />