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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: Jon Mueller <br /> Permittee Company: Grand Junction Pipe&Supply Co. <br /> Address: 556 Struthers Ave. <br /> Grand Junction, CO 81501-3826 <br /> Phone Number: (970)243-4604 <br /> Fax Number: (970)243-6703 <br /> Email Address: Jonmueller@elamconstruction.com <br /> Permitting Contact: Jon Mueller <br /> Company: Grand Junction Pipe&Supply Co <br /> Address: 556 Struthers Ave. <br /> Grand Junction, CO 81501-3826 <br /> Phone Number: (970)243-4604 <br /> Fax Number: (970)243-6703 <br /> Email Address: <br /> Inspection Contact: Jon Mueller <br /> Company: Grand Junction Pipe& Supply Co <br /> Address: 556 Struthers Ave. <br /> Grand Junction, CO 81501-3826 <br /> Phone Number: (970)243-4604 <br /> Fax Number: (970)243-6703 <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 Div' io approved mining and reclamation plans. <br /> o8 O� /7 <br /> Signature of Per ittee Coro to Offi , wner,or Documented Designee Date <br /> M-AF-01 <br />