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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: Russell A. Larsen <br /> Permittee Company: Elam Construction, Inc. <br /> Address: 556 Struthers Ave <br /> Grand Junction, CO 81501- <br /> 3826 <br /> Phone Number: (970)242-5370 <br /> Fax Number: (970)245-7716 <br /> Email Address: <br /> Permitting Contact: Ben Langenfeld \Cry ^ A"1ve�U( <br /> Company: Greg Lewicki and Associates J 1 <br /> Address: 11541 Warrington Ct. 7 S-o LL� rs (A 4en <br /> ue- <br /> Parker, CO 80318 <br /> ec, <br /> Phone Number: (303)346-5196 <br /> Fax Number: (303)346-6934 < 24 } , <br /> Email Address: <br /> Inspection Contact: Jon Mueller <br /> Company: Elam Construction, Inc. <br /> Address: 556 Struthers Ave. <br /> Grand Junction, CO 81501- <br /> 3826 <br /> Phone Number: (970)242-5370 <br /> Fax Number: (970)245-7716 <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 /> being conducted in accordance wit he Division approved mining and reclamation plans. <br /> " J� <br /> CJ4" 1 k 06 . 06 - 2b)7 <br /> Signature of Per tee Cor ora'a Officer,Owner,or Documented Desi¢nee Date <br /> M-AF-01 / <br />