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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: <br />Chris Zadel <br />Permittee Company: <br />Northern Colorado Constructors, <br />Inc. Aggregate Div <br />Address: <br />9075 WCR 10 <br />Fort Lupton, CO 80621 <br />Phone Number: <br />(303) 857-1754 <br />Fax Number: <br />(303) 857-2933 <br />Email Address: <br />Permitting Contact: <br />Ken Rollin <br />�.�. Yap►; <br />Company: <br />Rollin Consulting <br />�T Consv l�-in <br />Address: <br />840 Eagle Dr. <br />305 <br />Eaton, CO 80615-9086 <br />s � it— D <br />,.� L. ? ,h. , Go t? 0 62 k <br />Phone Number: <br />(970) 454-0404 <br />Fax Number: <br />(970) 454-2847 <br />622-( <br />Email Address: <br />` vk. <br />Y ��--t oohs,, t ;h . COw% <br />Inspection Contact: <br />Chris Zadel <br />Company: <br />Northern Colorado Constructors, <br />Inc. Aggregate Div <br />Address: <br />9075 WCR 10 <br />Ft. Lupton, CO 80621 <br />Phone Number: <br />(970) 587-4394 <br />Fax Number: <br />(970) 587-4397 <br />Email Address: <br />C. %el 57 cons-{-cors. c.o�+. <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 />Signature of Permittee. Corporate Officer, Owner, or Documented Designee <br />M -AF -01 <br />Date <br />