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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: Lonny Graves <br /> Permittee Company: Pine Bluffs Gravel & <br /> Excavating, Inc <br /> Address: PO Box 609 <br /> Pine Bluffs , WY 82082 <br /> Phone Number: (307)245-3676 <br /> Fax Number: (307)245-3748 <br /> Email Address: Lonny@pbgravel.com <br /> Permitting Contact: 1Beug*el4w <br /> Company: Pine Bluffs Gravel <br /> Address: PO BOX 609 <br /> Pine Bluffs, Wy 82082 <br /> Phone Number: (304)245 4426 <br /> .�-� -ass-31(P <br /> Fax Number: �zn7»dt_z^S7 'J0--j —AtA6- 3-74� <br /> Email Address: <br /> Inspection Contact: a KZUer <br /> Company: Pine Bluffs Gravel <br /> Address: PO BOX 609 <br /> Pine Bluffs, Wy 82082 <br /> Phone Number: -(397'2^G-2^2266 <br /> 3b---7(A <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 ivision approved mining and reclamation plans. <br /> t <br /> I <br /> Signature o Permittee Cor ,orat r,Owner,or Documented Designee Dat <br /> M-AF-01 <br />