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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: Tyler E.Kimzey <br /> Per Company: Pine Bluffs Gravel& 1 <br /> Excavating, Inc. <br /> Address: 600 Parson Street <br /> P.O. Box 609 <br /> Pine Bluffs, WY 82082 <br /> Phone Number: (307)245-3676 <br /> Fax Number: (307)245-3748 <br /> Email Address: <br /> Permitting Contact: l0e43rI leF Ac -�y 1£,- vL;,,,-‘ . <br /> Company: Pine Bluffs Gravel & <br /> Excavating,Inc. <br /> Address: _'__` '_` ret \ \ c r <br /> P.O. Box 609 <br /> Pine Bluffs,WY 82082 <br /> Phone Number: .(307)215-3426 t \e__ _. <br /> Fax Number: (307)245-3748 <br /> Email Address: <br /> Inspection Contact: ler— <br /> Company: Pine Bluffs Gravel & <br /> Excavating, Inc. <br /> Address: 5 , \e_\— <br /> P.O. Box 609 <br /> Pine Bluffs, WY 82082 <br /> Phone Number: (307)245 3426 '\ ._\-e 0- ) .3,-V7_ 3ic-)le <br /> Fax Number: (307)245-3748 <br /> Email Address: <br /> I,the undersigned,hereby state that the ' formation provided in this report is true and accurate, and that site operations are <br /> being conducted in accordance w•th t ivision approved mining and reclamation plans. <br /> (1404 <br /> _____ja_ 1 <br /> Signature of Permittee,Corporate 0 icer,Owner,or Documented Designee Date <br /> M-AF-01 <br /> fr . z ( . <br /> c ( <br />