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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: Ken Evans <br /> Permittee Company: Reclamation Ridge,LLC <br /> Address: P.O. Box 1 <br /> Denv ,CO 80209 P.O. Box 204 <br /> s Granby, CO 80446 <br /> Phone Number: (970)887- 95 <br /> 970-531-8719 <br /> Fax Number: (970 87-9579 303-635-6126 <br /> Email Address: gravelkingjr@yahoo.com <br /> Permitting Contact: Ken Evans <br /> Company: Reclamation Ridge,LLC <br /> Address: PO Box9 t <br /> Derv�pK,CO 80209 P.O. Box 204 <br /> Granby, CO 80446 <br /> Phone Number: (970)887- 95 970-531-8719 <br /> Fax Number: (970) 7-9579 303-635-6126 <br /> Email Address: gravelkingjr@yahoo.com <br /> Inspection Contact: Ken Evans <br /> Company: Reclamation Ridge, LLC <br /> Address: P O Box 9 t <br /> Denver, O 80209 P.O. Box 204 <br /> Granby, CO 80446 <br /> Phone Number: (970)887-89 5 <br /> 970-531-8719 V <br /> Fax Number: (970)8 -9579 303-635-6126 ✓ <br /> Email Address: gravelkingjr@yahoo.com <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 with the Division approved mining and reclamation plans. <br /> Manager <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> "-AF.O1 <br />