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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: Thomas E.Brubaker <br /> Permittee Company: VALCO, INC. <br /> Address: 9296 Windhaven Dr. <br /> Parker,CO 80134 <br /> Phone Number: <br /> Fax Number: <br /> Email Address: <br /> Permitting Contact: Thomas E.Brubaker <br /> Company: VALCO, INC. <br /> Address: 9296 Windhaven Dr. <br /> Parker, Co 80134 <br /> Phone Number: - 0 ( � let <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Thomas E.Brubaker <br /> Company: VALCO, INC. <br /> Address: 9296 Windhaven Dr. <br /> Parker,Co 80134 <br /> Phone Number: 9 e I q> <br /> Fax Number: !/ <br /> Email Address: <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 /> 20(7 <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />