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4 <br /> 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: Robin Varelman <br /> Permittee Company: SA Aggregate LLC <br /> Address: 31015 County Road K / <br /> Brush,CO 80723 3 q or, ,-'y�10n T2C Ij <br /> a;RE BRZ <br /> 5hPf TX ,--4 <br /> Phone Number: (970)380-3798 <br /> Fax Number: <br /> Email Address: Rlsage65@hotmail.com <br /> Permitting Contact: Robin Varelman 1 dw <br /> Company: 5A Aggregates LLC <br /> Address: 31015 County Road K ry a l a E <br /> Brush,CO 80723 .3 D"( <br /> S keP,I'Y1 Qrf ti �C 750�2 <br /> Phone Number. (970)380-379$ 1 y - <br /> Fax Number: i <br /> Email Address: Rlsage65@hotmail.com f 1„ <br /> 7(Jmail, <br /> Inspection Contact: Robin Varelman f l <br /> Company: 5A Aggregate LLC <br /> Address: 31015 County Road K �7 <br /> Brush,CO 807232 % �o"1 1��ec �.t U . <br /> Phone Number. (970)380-3798 q63 {� Q <br /> Fax Number. 0 0 <br /> Email Address: Rlsage65@hotmaii.com I ebard a IC25 r-o <br /> 1, dersigned,hereby state that the information provided in this report is true and accurate,and that sife operations are <br /> ing qonducpdacco ce with the Division approved mining and reclamation plans. <br /> ature of Permittee.Corporate Officer.Owner,or Documented Designee hlate <br /> M-AF01 <br />