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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: Roger Hageman <br /> Permittee Company: Glacier Rock Company <br /> Address: 3501 E. Prospect Road <br /> Ft. Collins,CO 80525 <br /> Phone Number: (970)221-7173 <br /> Fax Number: (970)221-7163 <br /> Email Address: Roger@hecinc.net <br /> Permitting Contact: Roger Hageman <br /> Company: Glacier Rock Company <br /> Address: 3501 E.Prospect Road <br /> Ft. Collins, CO 80525 <br /> Phone Number: (970)221-7173 <br /> Fax Number: <br /> Email Address: Roger@hecinc.net <br /> Inspection Contact: Roger Hageman <br /> Company: Glacier Rock Company <br /> Address: 3501 E.Prospect Rd. <br /> Ft. Collins, CO 80525 <br /> Phone Number: (970)221-7173 <br /> Fax Number: <br /> Email Address: Roger@hecinc.net <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 /> � D ' 7 <br /> Signature of Permifid,Corporate O ce ,Owner,or Documented Desiinee baie <br /> M-AF-01 <br />