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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. dba <br /> Sandco, lnc. <br /> Address: 556 Struthers Ave. <br /> Grand Junction, CO 81501 <br /> Phone Number: (970)242-5370 <br /> Fax Number: (970)245-7716 <br /> Email Address: Russ.larsen@elamconstruction.com <br /> Permitting Contact: Jon Mueller <br /> Company: Elam Construction, Inc. dba <br /> Sandco, Inc. <br /> Address: 556 Struthers Ave. <br /> Grand Junction, CO 81501 <br /> Phone Number: (970)242-5370 <br /> Fax Number: (970)245-7716 <br /> Email Address: <br /> Inspection Contact: Jon Mueller <br /> Company: Elam Construction, Inc. dba <br /> Sandco, Inc. <br /> Address: 556 Struthers Ave. <br /> Grand Junction, CO 81501 <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 with the Div' i n approved mining and reclamation plans. <br /> Signature of Per ittee Corporad Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />