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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: Shane Galles <br /> Permittee Company: DRY CREEK GULCH FARMS, <br /> LLC. <br /> Address: 505A East 8th Ave. <br /> Yuma, CO 80759 <br /> Phone Number: (970)630-4500 <br /> Fax Number: (97 - 505 <br /> Email Address: Casside a oo.com <br /> Permitting Contact: Shane Galles <br /> Company: DRY CREEK GULCH FARMS, <br /> LLC. <br /> Address: 505A East 8th Ave. <br /> Yuma, CO 80759 <br /> Phone Number: (970)848-8402 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Shane Galles <br /> Company: DRY CREEK GULCH FARMS, <br /> LLC. <br /> Address: 505A East 8th Ave. <br /> Yuma, CO 80759 <br /> Phone Number: (970 V <br /> Fax Number: l� <br /> Email Address: <br /> 1,the undersigned,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> Aqued in acco danc ith the Division approved mining and reclamation plans. <br /> rmittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />