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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: Lois Hybarger <br /> Permittee Company: Flat Top Flagstone,LLC <br /> Address: 2695 Patterson Road <br /> Suite 2-320 <br /> Grand Junction, CO 81506 <br /> Phone Number: (970)314-1076 <br /> Fax Number: <br /> Email Address: Lois@lfhope.org <br /> Permitting Contact: Lois Hybarger <br /> Company: Flat Top Flagstone, LLC <br /> Address: 2454 Patterson Road Suite 210 2(0�15 cSptJ <br /> Grand Junction, CO 81505 SLL�9C <br /> &\Z, nc` `s 1 ,bcp <br /> Phone Number: (970)255-8088 G-7 O }� <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Lois Hybarger <br /> Company: Flat Top Flagstone, LLC <br /> Address: 2454 Patterson Road Suite 210 Z�C� �(� CSt�r1 Q OC9 <br /> Grand Junction, CO 81505 <br /> X.u-V 2 -7->2c <br /> Phone Number: (970)255-8088 <br /> gib Say -ion <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 /> n -- p --- - <br /> Signature of Permittee,Corpo ate Ofdcer,Owner,or Documented Designee Date <br /> M-AF-01 (\/' <br />