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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: William Van Valkenburg Ok)6�5 VQ r) vo_ /ken b UP-) <br /> Permittee Company: Van Valkenburg Cattle <br /> Com an , LLC 4 M-�- <br /> Address: 12353 Hwy 14 <br /> Walden, CO 80480 ).�-3 5 3 OWL-0/ <br /> CD OL I fvl�V�-�/ (0 �q3° <br /> Phone Number: (970)723-4346 723 _44 5 1 8 <br /> Fax Number: <br /> Yn <br /> Email Address: Dnr_drmsminadmin@state.co.us <br /> Permitting Contact: Kent Holsinger <br /> Company: Holsinger Law,LLC <br /> Address: 1800 Glenarm Place, Suite 500 <br /> Denver, CO 80202 <br /> Phone Number: (303)722-2828 <br /> Fax Number: (303)496-1025 <br /> Email Address: Dnr—drrnsminadmin@state.co.us <br /> Inspection Contact: William Van Valkenburg QA S c�//OLD'V la+ LeKbIAY 9/ <br /> Company: Van Valkenburg Cattle 1 F <br /> Company,LLC <br /> Address: 12353 Hwy 14 <br /> Walden, CO 80480 1 2-35 3 �y 1 <br /> Phone Number: (970)723-4346 q7b '7.Z 3 �4S/g v <br /> Fax Number: l <br /> Email Address: Dnr_drmsminadmin@state.co.us <br /> I,the undersigned,hereby state that the information provided in this report is true and accurate, and th site perations are <br /> being conducted in accordance with the Division approved mining and reclamation plans. <br /> Signature of Permittee,Corporate Officer,Ow r,or Documented Designee Date <br /> M-AF-01 <br />