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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: Chris .Baer <br /> Permittee Company: Grand County <br /> Address: P.O.IBox 9 <br /> Granby, CO 80446 <br /> Phone Number: (970) 887-2123 <br /> Fax Number: (970)887-3168 <br /> Email Address: <br /> Permitting Contact: Steve O'Brian <br /> Company: Environment,Inc <br /> Address: 7985 Vance Dr. 4205A <br /> Arvada, CO 80003 <br /> Phone Number: (303)423-7297 <br /> Fax Number: (303)423-7599 <br /> Email Address: <br /> Inspection Contact: Bill Clark <br /> Company: Grand County <br /> Address: P.O. Box 9 <br /> Grandby,CO 80446 <br /> Phone Number: (970)887-2123 <br /> Fax Number: (970)887-3168 <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 /> s d <br /> Si ature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />