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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: Kerry Halde <br /> Permittee Company: Halde Sand&Grav 1, Inc. <br /> Address: 46321 US Highway 24 <br /> Burlington, CO 80807 <br /> Phone Number: (719)346-0352 <br /> Fax Number: (719)346-8945 <br /> Email Address: Haldesand@centurytel.net <br /> Permitting Contact: Kerry Halde <br /> Company: Halde Sand&Gravel, Inc. <br /> Address: 46321 US Highway 24 <br /> Burlington,CO 80807 <br /> Phone Number: (719)346-0352 <br /> Fax Number: (719)346-8945 <br /> Email Address: <br /> 0.0 0, n r r <br /> Inspection Contact: Kerry Halde <br /> Company: Halde Sand&Gravel,Inc. <br /> Address: 46321 US Highway 24 <br /> Burlington, CO 80807 <br /> Phone Number: (719)346-0352 <br /> Fax Number: (719)346-8945 <br /> Email Address: l <br /> tr�a��sa►-1c� rt�� ,tie. <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 /> Signature of Per i Cgivorate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />