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Page 3 of3 <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 /> Prrn ittee C"ANZ Bob Baclm <br /> Permittee Company: Delta County <br /> Address: 501 Palmer St Ste 227 <br /> Delta, CO 81416 <br /> Phone Number: (970)874-5914 <br /> Fax Number: (970)874-2455 <br /> Email Address: Bbasher@deltacounty.com <br /> Permitting Contact: Garold� <br /> Company: Delta County <br /> Address: 501 Palmer St Ste 227 <br /> Delta, CO 81416 <br /> Phone Number: (970)874-2108 <br /> Fax Number: (970)874-2114 — <br /> Email Address: / <br /> /Q ME wi+i.•vWd y�C�c�7Acd✓.v7Y,G0"--1 <br /> Inspection Contact: John-T-in+re-za•-•,,,.y,i1;:d /�QQ y Q,G�Q� ✓ <br /> Company: Delta County <br /> Address: 501 Palmer St Ste 227 <br /> Delta, CO 81416 <br /> Phone Number: (970)874-2100 <br /> Fax Number: 470-Sly-0-;2 f(o <br /> Email Address: <br /> LR,&v.-4v 1? d6LTALoaw7 , Go,r, ✓ <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 /> Signature of PWinittee,Corporate Officer,Owner,of Documented Desi nee 6ate <br /> M-AF-04 <br />