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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: Mike Bucklen <br /> Permittee Company: Bucklen Equipment Company, <br /> Inc. <br /> Address: 804 N 25th Ave <br /> Greeley,CO 80631 <br /> Phone Number: (970)353-0720 <br /> Fax Number: (970)353-0721 <br /> Email Address: <br /> Permitting Contact: Carrie Herbolsheimer <br /> Company: Applegate Group, Inc. <br /> Address: 1490 W. 121st Ave., Ste. 100 <br /> Denver, CO 80234 <br /> Phone Number: (303)452-6611 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Judy May <br /> Company: Bucklen Equipment Company, <br /> Inc. <br /> Address: 804 N 25th Ave <br /> Greeley, CO 80631 <br /> Phone Number: (443)-62-3-02.59- <br /> 110 353 -01 .0 ✓ <br /> Fax Number: <br /> Cn C- Q 35.3 —01 a \ ✓ <br /> Email Address: <br /> I,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 "ining and reclamation plans. <br /> �'�/j/ 4al -� 117 <br /> Signature ofPermittee,Corporate icer,Owner,or Documented Designee Date <br /> M-AF•0I <br />