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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: Jay L. Wagner <br /> Permittee Company: Wagner Construction Inc. <br /> Address: 1850 E. 1st Street <br /> Craig, CO 81625 <br /> Phone Number: (970)824-2709 <br /> Fax Number: (970)824-2709 <br /> Email Address: <br /> Permitting Contact: Jay L. Wagner <br /> Company: Wagner Construction Inc. <br /> Address: 1850 E. 1st Street <br /> Craig, CO 81625 <br /> Phone Number: (970)824-2709 <br /> Fax Number: (970)824-2709 <br /> Email Address: <br /> Inspection Contact: Jay L. Wagner <br /> Company: Wagner Construction Inc. <br /> Address: 1850 E. 1 st Street <br /> Craig,CO 81625 <br /> Phone Number: (970)824-2709 <br /> Fax Number: (970)824-2709 <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 /> 4 ,V X7 <br /> Signat6'e'o evrmitteelCorporate Officer,Owner,or Documented Desienee Date <br /> M-AF-01 <br />