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Page 5 of 5 <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 />Permittee Contact: <br />Todd Fisher <br />Permittee Company: <br />LBCR, LLC <br />Address: <br />1440 Blue Sage Ct. <br />Boulder, CO 80305 <br />k <br />i <br />Phone Number: <br />(30) 388-7395 <br />Fax Number: <br />Email Address: <br />Permitting Contact: <br />Mao Garnallan <br />J <br />Company: <br />1 rs�d--h�ftil'St. <br />P4 -Burt93-1 <br />B" ieM-, CO --9M2 <br />Address: <br />s <br />,o o C3 3 s ---L <br />T511 ac.i L) Cca 9/13 7 <br />Phone Number: <br />3 <br />9 70 - `/ V --L • Co L 3 ca <br />ciao - 9vle - Ig(v[o cel <br />Fax Number: <br />(WOYR4-5962 <br />Email Address: <br />Inspection Contact: <br />N4e#jG&mairan <br />Company: <br />Address: <br />IS-W.-}Aitm. <br />P 4. BVX 9H <br />Bay e1 9�1-t22 <br />C i4 5 <br />Po d •c 35 Z <br />���?4c,'U 97/3 7 <br />Phone Number: <br />970 - 9Y4 - <br />YG-Fax <br />Fax Number: <br />(9-70) 884-506 <br />Email Address: <br />to C4 s jo-ct �e / - e -o en <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 />• s <br />Signature o ermittee drwkate Officer <br />Owner. or Documented Designee <br />MAF 81 ! <br />ce'ql v I <br />1�- <br />Date <br />