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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: n n- <br /> � <br /> Permittee Company: City of Arvada <br /> Address: 8101 Ralston Rd <br /> Arvada, CO 80002 <br /> Phone Number: ( 6}-!}HS- i'82- —7 O 9 g 7a/ <br /> Fax Number: (720)898-7603 <br /> Email Address: <br /> s'C <br /> Permitting Contact: Pe+P,r Ad_ler <br /> s s"�rLL>ce�i✓ <br /> Company: City of Arvada <br /> Address: 8101 Ralston Rd <br /> Arvada,CO 80001 <br /> Phone Number: (7� <br /> 0) <br /> Fax Number: <br /> Email Address: -Pad1Q;4a^»aa.^ <br /> Inspection Contact: Pe*r Adier /9/V <br /> Company: City of Arvada <br /> Address: 8101 Ralston Rd <br /> Arvada,CO 80001 <br /> Phone Number: - C7)62) <br /> 7 7`/ <br /> Fax Number: 7 �i <br /> Email Address: CIP V VIVA,Lwe� <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 /> d9-lam T� <br /> Sign re of Permit ee,Corporate Officer,Owner,or Documented Desienee Date <br /> M-AF-04 <br />