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Page 5 of 5 <br /> <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: <br /> <br />Bill Clark <br />Permittee Company: <br /> <br />Grand County <br />Address: <br /> <br /> <br /> <br />P.O. Box 9 <br />Granby, CO 80446 <br /> <br />Phone Number: <br /> <br />(970) 887-2123 <br />Fax Number: (970) 887-3168 <br />Email Address: Bclark@co.grand.co.us <br />Permitting Contact: <br /> <br />Steve O’Brian <br />Company: <br /> <br />Environment, Inc. <br />Address: <br /> <br /> <br /> <br />7985 Vance Dr Ste 205A <br />Arvada, CO 80003 <br /> <br />Phone Number: <br /> <br />(303) 423-7297 <br />Fax Number: (303) 423-7599 <br />Email Address: <br />Inspection Contact: <br /> <br />Ken Haynes <br />Company: <br /> <br />Grand County <br />Address: <br /> <br /> <br /> <br />P.O. Box 9 <br />467 E. Topaz Ave. <br />Granby, CO 80446 <br /> <br />Phone Number: <br /> <br />(970) 887-2123 <br />Fax Number: (970) 887-3168 <br />Email Address: <br /> <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 /> <br /> <br /> <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date <br /> <br />M-AF-04