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Page 5of5 <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: Chris Baer <br /> Permittee Company: Grand County <br /> Address: P.O. Box 9 <br /> Granby, CO 80446 <br /> Phone Number: (970)887-2123 <br /> Fax Number: (970)887-3168 <br /> Email Address: Cbaer@co.grand.co.us <br /> Permitting Contact: Steve O'Brian <br /> Company: Environment, Inc <br /> Address: 7985 Vance Dr. #205A <br /> Arvada,CO 80003 <br /> Phone Number: (303)423-7297 <br /> Fax Number: (303)423-7599 <br /> Email Address: <br /> Inspection Contact: Bill Clark <br /> Company: Grand County <br /> Address: P.O. Box 9 <br /> Granby, CO 80446 <br /> Phone Number: (970)887-2123 <br /> Fax Number: (970)887-3168 <br /> Email Address: Bclark@co.grand.co.us <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 /> /.2/4/z 0/ <br /> Signatu f Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />