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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: William Van Valkenburg Ch ri c ' a.t ken burl <br /> Permittee Company: Van Valkenburg Cattle , , p <br /> Company, LLC �}-�I ' <br /> Address: 12353 Hwy 14 <br /> Walden, CO 80480 <br /> Phone Number: (970)723-4346 q7 b -72-3 �P5 I B <br /> Fax Number: (970) 723-4518 5 l ti <br /> Email Address: C OO,r)Osai ke r p � Q • °in <br /> Permitting Contact: William Van Valkenburg J <br /> Ch r 5 \1Ct -11CclA0 u,r-- <br /> Company: Van Valkenburg Cattle <br /> Company, LLC p,ev.. ` <br /> Address: 12353 Hwy 14 <br /> Walden,CO 80480 <br /> Phone Number: (970) 723-4346 Q,1O X723—451 <br /> Fax Number: (970) 723-4518 <br /> Email Address: Cr.U111Ocal a, 6. <br /> 10%- <br /> Inspection Contact: William Van Valkenburg <br /> hr-L 5 Vaal ke,i'U, <br /> Company: Van Valkenburg Cattle <br /> Company,LLC AAAA..)� <br /> Address: 12353 Hwy 14 <br /> Walden,CO 80480 <br /> brwa <br /> Phone Number: (970)723-4346 <br /> O -723 -- t <br /> Fax Number: (970) 723-4518 <br /> Email Address: Cf_.A 3an'(-\ Re n 1)uY (,Qh,.Cam <br /> I,the undersigned,hereby state that the information provided in this report is true and accurate,and that site operons are <br /> being conducted in accordance with the Division approved mining and reclamation plans. <br /> CA1,411 ' 0 - 17 <br /> �i�iij� �� <br /> Signature of Perini 1 e,Corporate Officer, ner,or Documented Designee RECEIVED <br /> g �� <br /> M-AF-UI <br /> 'll/v RECEIVED <br /> ��S NOV 2 8 2011 <br /> N\-- \r-( <br /> NOV 2011DIVISION OF RECLAMATION <br /> MINING AND SAFETY <br /> DIVISION Cs:F RECLAMATION,MININGGB� �� Q°j' <br />