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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: Tom Brubaker <br /> Permittee Company: VALCO,INC. <br /> Address: 9296 Windhaven Dr. <br /> Parker, CO 80134 <br /> Phone Number: (719)469-0840 <br /> Fax Number: 4343-)- � <br /> Email Address: Tom.brubaker@valco-inc.com <br /> Permitting Contact: Thomas E.Brubaker <br /> Company: VALCO, INC. <br /> Address: 9296 Windhaven Dr. <br /> Parker, CO 80134 <br /> Phone Number: 7t g g 6 f ,0$' IQ <br /> Fax Number: <br /> Email Address: Tom.brubaker@valco-inc.com <br /> Inspection Contact: Thomas E.Brubaker <br /> Company: VALCO, INC. <br /> Address: 9296 Windhaven Dr. <br /> Parker,CO 80134 <br /> Phone Number: I (4 6 ®15�1 a <br /> Fax Number: <br /> Email Address: Tom.brubaker@valco-inc.com <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 /> afo&.4.0-7 sztw"' Lh4ji '? <br /> Signature of Permittee,Corporate Office Owner,or Documented Designee Date <br /> M-AF-01 <br />