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Page 5 of 5 <br />Division records indicate the following permitteellandowner 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: <br />Jack Miller <br />!G L� <br />Permittee Company: <br />Superior Oilfield Services Co., <br />LTD <br />Zc � fifJ � �r 0* -JZ —13 <br />Address: <br />1011 1 Ith Ave. <br />Greeley, CO 80631 <br />$ob�J <br />Phone Number: <br />(970) 352-4444 <br />Fax Number: <br />(970) 353-0139 <br />Email Address: <br />Rick.m5 laseroilficld.com <br />Permitting Contact: <br />Michael Miller <br />Company: <br />Superior Oilfield Services Co., <br />LTD <br />Address: <br />14280 CR 72 <br />Z9� �� Sr1�rJ3 <br />P.O. Box 336356 <br />Greeley, CO 80633�`"�y+ <br />Phone Number: <br />(970) 454-3222 <br />Fax Number: <br />(970) 4548723 <br />Ismail Address: <br />Inspection Contact: <br />Michael Miller <br />✓ <br />Company: <br />Superior Oilfield Services Co., <br />LTD <br />Address-, <br />14280 CR 72 <br />P.O. Box 336356 <br />�►r��1, `� <br />moi` <br />Greeley, CO 80633 <br />3� <br />Phone Number: <br />(970) 454-3222 <br />Fax Number: <br />(970) 454-8723 <br />Email Address: <br />com <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 />— wa-/� _ 1, P% -f <br />Signature o Permittee, Corporate Officer, Owner, or Documented Desienee Date <br />U-.0 <br />