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Pagc 5 of 5 <br /> Division records indicate the following permittee/lando►vner 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: Donnie Dustin <br /> change to: Daylan Figgs <br /> Permittee Company: City of Fort Collins <br /> same <br /> Address: 700 Wood Street <br /> P.O. Box 580 P.O. Box 580 <br /> Fort Collins,CO 80522 <br /> Fort Collins, CO 80522 <br /> Phone Number: (970)416-2053 (970) 416-2814 <br /> Fax Number: <br /> Email Address: Ddustin@fcgov.com dfiggs@fcgov.com <br /> Permitting Contact: <br /> Company: <br /> Address: <br /> Phone Number: <br /> Fax Number: <br /> Emai I Address: <br /> Inspection Contact: Donnie Dustin <br /> change to: Daylan Figgs <br /> Company: <br /> Address: 700 Wood Street P <br /> P.O. Box 580 P.O. BOX 580 <br /> Fort Collins,CO 80522 Fort Collins, CO 80522 <br /> Phone Number: (970)4I6-2053 970 416-2814 <br /> Fax Number: <br /> Email Address: Dnr—drTnsminadmin@state.co.us dfl S fc OV.COm <br /> 1,the undersigned,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> being cond d in accordance wit h ivision approved mining and reclamation plans. <br /> � l0 Zo6 <br /> signativie of Permittee,Coraorate Officer,Owner,or Documented Resigne bate <br /> M-AF44 <br />