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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: Rudy Bevan <br /> Permittee Company: Mesa County <br /> Address: P.O. Box 20000-5025 <br /> Grand Junction, CO 81502 <br /> Phone Number: (970)244-1895 <br /> Fax Number: (970)243-3519 <br /> Email Address: Rudy.bevan@mesacounty.us <br /> Permitting Contact: <br /> R�.d air <br /> Company: Mesa County <br /> Address: P.O. Box 20000-5025 <br /> Grand Junction, CO 81502- <br /> 5025 <br /> Phone Number: (970)244-1807 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: 4Feb- <br /> (�v�,dy <br /> Company: Mesa County <br /> Address: P.O.Box 20000-5025 <br /> Grand Junction, CO 81502- <br /> 5025 <br /> Phone Number: (970)244-1807 _ <br /> o,- quo -Z�4- �SqS t/ <br /> Fax Number: <br /> a,0 - Zy3 - 35ta V/ <br /> Email Address: <br /> V-1 <br /> I,the undersigned,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> bei ducted in accordanc with the Division approved mining and reclamation plans. <br /> cl-<— <br /> Signature of PLrmittok Corporate Officer,Owner,or Documented Designee 6ate <br /> M-AF-04 <br />