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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: <br />Byron R. Chrisinan <br />,J a c. L I%G r r a -- <br />S Vq <br />Permittee Company: <br />Tomichi Materials, LLC <br />fI / <br />�+n <br />l <br />Address: <br />864 W. Boulder Road,Suite 200 <br />Louisville, CO 80027 <br />Fre �� I` C' <br />Phone Number: <br />(303) 938-8200 <br />335Fa303 S9/ 7535- <br />Fax <br />x Number: <br />Email Address: <br />Byron@chrismanc.com <br />, <br />a c. ✓a r rn Q i Lam. <br />Permitting Contact: <br />Byron R. Chrisman <br />L7/ , p <br />Company: <br />Tomichi Materials' LLC <br />T o m. s � �l. � t�►��t �' LCL <br />Address: <br />864 W. South Boulder Road <br />Louisville, CO 80027 <br />�r <br />F12- 0 (� S <br />Phone Number: <br />(303) 938-8200 <br />3 0 3 5-9/ <br />Fax Number: <br />Email Address: <br />Byron@chrismanc.com <br />cc 6 V, Ci r f /. GSL <br />Inspection Contact: <br />Byron R. Chrisman <br />JaC,�. P,s V9►rrc-4- <br />1/a <br />Company: <br />Tomichi Materials, LLC <br />Address: <br />864 W. South Boulder Road <br />Louisville, CO 80027 <br />Phone Number: <br />(303) 938-8200 <br />i <br />Fax Number: <br />Email Address: <br />Byron@chrismanc.com <br />I, the undersigned, hereby state that the information provided in this report is true and accurate, and th t site operations are <br />being conducted in accordance with the Division approved mining and reclamation plans. <br />FE <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee <br />M -AF -04 <br />G} 7h -> <br />bate <br />i <br />