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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: James Simpson <br /> Permittee Company: Arnolds Custom Seedi g,LLC <br /> Address: 4626 WCR 65 <br /> Keenesburg, CO 80643 <br /> Phone Number: (303)710-0476 <br /> Fax Number: (303)732-0510 <br /> Email Address: Slicer@acsseeding.com <br /> Permitting Contact: Rick Gillan <br /> Company: Arnold's Custom Seeding,LLC <br /> Address: 4626 WCR 65 <br /> Keenesburg, CO 80643 <br /> Phone Number: (303)732-4021 <br /> Fax Number: <br /> Email Address: Rgillan@acsseeding.com <br /> Inspection Contact: Rick Gillan <br /> Company: Arnold's Custom Seeding,LLC <br /> Address: 4626 WCR 65 <br /> Keenesburg, CO 80643 <br /> Phone Number: (303)732-4021 <br /> Fax Number: <br /> Email Address: Rgillan@acsseeding.com <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 /> Signr e of Permi eC orateOfficer,Owner,or Documented Desianee Date <br />