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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: Russell A.Larsen <br /> Permittee Company: Grand Junction Concrete Pipe <br /> Co. <br /> Address: 556 Struthers Ave. <br /> Grand Junction, CO 81501- <br /> 3826 <br /> Phone Number: (970)245-9301 <br /> Fax Number: (970)243-6703 <br /> Email Address: <br /> Permitting Contact: Jon Mueller <br /> Company: Grand Junction Concrete Pipe <br /> Co. <br /> Address: 556 Struthers Ave <br /> Grand Junction, CO 81502 <br /> Phone Number: (970)243-4604 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Jon Mueller <br /> Company: Grand Junction Concrete Pipe <br /> Co <br /> Address: 556 Struthers Ave. <br /> Grand Junction, CO 81501- <br /> 3826 <br /> Phone Number: (970)243-4604 <br /> Fax Number: <br /> Email Address: <br /> I,the undersigned,hereby state that the inform ion provided in this report is true and accurate, and that site operations are <br /> being conduct ccordance witj h�Divi o approved mining and reclamation plans. <br /> 7 / <br /> Signature of Peii4ittee,Cor orate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />