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Pages aPS <br /> Divon re frds IM—rate the following parnittedlandowner contact information(1l ik fields iraEcrex that we a ma----°` <br /> information on record). If this information is blank or not current,please type or print current contact information <br /> I Te.uniueeGasinet: I lames101adllauakl i <br /> ? .t <br /> - -1C.�( _ <br /> 1 <br /> Address: T-1402 W 44th Avenue <br /> Golden,CO 80403 <br /> • <br /> Phone Number: (303)279-6611 <br /> Fax Number: (303)279-6216 <br /> Email Address: Jmacdonald@apcsouthern.com <br /> Permitting Contact: Richard Pounds <br /> Company: APC Southern Construction Co., <br /> LLC <br /> Address: /`18,+C►.c W `1 ki 0-ve, <br /> Pe .e:,C 40 <br /> C'_c, ( et z,.. efjc:). Vit''jti3 <br /> Phone Number: (719)406-8331 <br /> Fax Number: <br /> 3C3 <br /> -.2-27- 6:2/A,Z71l6:2/A, <br /> Email Address: <br /> Inspection Contact: Richard Pounds <br /> Company: APC Southern Construction Co., <br /> LLC <br /> Address: rignvresar. /'ycYC1 ii.' 44. (A-•144"-- <br /> Phone Number: (719)406-8331 <br /> Fax Number: 30 3 _D 7 y _ C:2 I 6, <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 /> ?T,z zj—&-- <br /> o-C•C,:1'; (2 /..,?:L.., Pv-4.2s,,`L-C.,kir- ii teei 20 i 2 <br /> S nature of Permittee, Co porate Officer,Owner,or Documented Designee Date <br /> M-AF i <br />