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Page 5 of 5 <br /> ThVision records indicate the following permitteellandowner contact information(blanklields-indicate that we do not-have <br /> information on record). If this information is blank or not current,please type orprint current contact information <br /> Wrmittee C MUCt J TonvBobYw <br /> Permittee Company- 11 CitV ofDekk <br /> Address: 360 Main Street <br /> Delta, CO 81416 <br /> Phone Number: (970)874-7973 <br /> Fax Number: (970)874-1353 <br /> Email Address: Tony@cityofdelta.net <br /> Permitting Contact: y <br /> Company: City of 961ta <br /> Address: 360 Main Street <br /> Delta, CO 81416 <br /> Phone Number: (970)874--- sf <br /> Fax Number: ( 7d �, 7-74 f' Y/ <br /> Email Address: c .i J� r <br /> c (? Cr <br /> Inspection Contact: <br /> © G i <br /> Company: City of Delta <br /> Address: 360 Main Street <br /> Delta, CO 81416 <br /> Phone Number: (970)874--0;56& <br /> .lei l 3 <br /> Fax Number: t�'�; IP-14 - 0 S 3 ✓ <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 mining and reclamation plans. <br /> to ' J�+ <br /> Sign ture of Odrmittee.Cor ,ora fficer,Owner,or Documented Designee D to <br /> 10 <br /> M-AF-04 <br />