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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: Adam Larson <br /> Permittee Company: ORDWAY FEEDYARD LTD. <br /> LIABILITY CO. <br /> Address: 19424 Hwy 96 <br /> Ordway, CO 81063 <br /> Phone Number: (719)250-8982 <br /> Fax Number: <br /> Email Address: Adam@ordwaycattlefeeders.net <br /> Permitting Contact: Adam Larson <br /> Company: Ordway Feedyard LTD Liability <br /> Co <br /> Address: 19424 Hwy 96 <br /> Ordway,CO 81063 <br /> Phone Number: (719)250-8982 <br /> Fax Number: <br /> Email Address: Adam@ordwaycattlefeeders.net <br /> Inspection Contact: Adam Larson <br /> Company: Ordway Feedyard LTD Liability <br /> Co. <br /> Address: 19424 Hwy 96 <br /> Ordway, CO 81063 <br /> Phone Number: (719)250-8982 <br /> Fax Number: <br /> Email Address: Adam@ordwaycattlefeeders.net <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 /> Signature of Permittee, ornorate Officer,Owner,or Documented DesiEnee Date <br /> M-AF-01 <br />