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Page 5 of 5 <br /> Division records indicate the following permittee contact information. If this information is not current,please type or print <br /> current contact information: <br /> Permittee Contact: Christie "~ Anastasia Frantsova <br /> Permittee Company: City of Greeley <br /> Address: 1100 10th Street, Suite 300 <br /> Greeley,CO 80631 <br /> Phone Number: - (970) 350-9806 <br /> Fax Number: (970)350-9805 <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 /> Ls Uw'- &,44 oyy- �'111 ZZa/7 <br /> Signature of Mermittee,Corporate Officer,Owner.or Documented Designee Date <br /> NI-AF-04 <br />