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Page S of i <br /> Division:cco;ds indicate the following perrnitteeiiandowncr contact information(blank fields indicate that we do not have <br /> information on record). H this inibi-oration is blan or not current,please type or print current contact information: <br /> Permittee Contact: ! Bradley Daliam -----? <br /> Permittee Company: I The City of Lafayette � �- <br /> f <br /> Address: - -' 1290 South Public Road <br /> I Laf vetle, CO 800216-2706 <br /> 1 <br /> 1'1iore Ntm;ber: (303)b65-v588 <br /> Fat Number- - --- (303)665-23 53 --- - -- --- --- -- <br /> Address: <br /> Permitting Contact. � Aaron Asquith <br /> %'IeLau hlin grater Engineers. --- <br /> ' Ltd. <br /> FAddi css -- <br /> 1 Deaver,CO 80211 <br /> Phone Nuttt�ncr: (303)96u-:33 43 � ----- <br /> Fax Number: { (3b3)964-3355 -- - <br /> F?t�ail Address• -' � - -------.._.._- __._. _ <br /> Inspection Contact: Aar�7n <br /> i <br /> McLaughlin Water Lngince-M, - ----- __-_.__-- -_-- _--- - <br /> Ltd. <br /> Address: ; 24.20 A,cott Street I <br /> Dznver.CO 80211 I <br /> I I <br /> 1 , <br /> Fax N:jmber: ---- - — 03;964-3355 -- <br /> i <br /> j Entail Address. - ----- <br /> I � <br /> 1,the undersigned, hereby State that the information provided in this report is true and acct.rat;,and that site onerat.ons are <br /> be;i,g conducx:;d in accordance with the Division approved mining and reclamation plans. <br /> Signature f Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF U1 <br />