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Pate 5 ot"S <br />Division records indicate the following permrttee,'landowner contact information (blank fields indicate that we do not ha\c <br />information on record) <br />If this information is blank or not current, please type or print current contact information. <br />Permittee Contact: <br />Julie Sevier <br />I <br />Permittee Company: <br />I <br />i Solberg Gravel LLC <br />Address: <br />Garrett Rd 1 <br />T1311-41 <br />Peyton. CO 80831 <br />- <br />Phone Number- - <br />-- (719) 683-3198 <br />�� - <br />Fax Number: <br />(719) 683-4373 <br />Email Address: <br />11seN,rerew;pioneersand.com <br />jPermitting Contact: <br />Robert Solberg <br />Company: <br />Solberg Gravel LLC <br />Address:- <br />-- - -- - - - <br />13745 Garrett Rd <br />Peyton. CO 80831-76"_'0 <br />Phone Number: <br />719) 683-3198 1 <br />Fax Number: <br />(719) 6834373 <br />Email Address: <br />Inspection Contact: <br />Robert Solberg <br />Company: <br />� P y= <br />Solberg Gravel LLC-�-^ _-- � �� ---�- ----� <br />Address: - - <br />-- - <br />13745 Garrett Rd i <br />i <br />Peyton, CO 80831-76_0 <br />( 719) 683-3198 <br />rPhone Number: <br />Fax Number: <br />(719) 683-4373 d <br />Email Address: <br />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 <br />with the Division approved mining and reclamation plans. <br />6.� � ti <br />4-4-2017 <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date <br />M. > 1 -N <br />