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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: Jennifer Rutter <br /> KvYt- Car I soy <br /> Permittee Company: Adams County <br /> Address: 4430 S. Adams County Parkway, q -�SS Nej'IdQO+� 'Rd <br /> 1 st Floor <br /> Brighton, CO 80601 $h�^t�, (o $oto01 <br /> Phone Number: (720) 523-6841 <br /> 303 (03'1 -So 13 <br /> Fax Number: (720)523-6998 <br /> 3o3- c03-1 -Sol S <br /> Email Address: Jrutter@adcogov.org <br /> kCaif-Dori @0.d c10 ov. <br /> Permitting Contact: Craig Tessmer <br /> Kuyl- CAr(Son <br /> Company: Adams County <br /> Address: 4430 S. Adams County Parkway, Coss wexxl�tzC1 <br /> 1 st Floor <br /> Brighton, CO 80601 51i�+011, Go 8 d l001 <br /> Phone Number: (720)523-6841 <br /> 3b3 -15 013 <br /> Fax Number: (720)523-6998 3o 3-(0'3 -� _g o, S <br /> Email Address: <br /> k car lse�v% eoacicIC) v. <br /> Inspection Contact: Jennifer Rutter k'Wy+ COX 1sle-1,, <br /> Company: Adams County <br /> Address: 4430 S.Adams County Parkway, C1-I S S Peh QkrwI` Rd <br /> 1 st Floor <br /> Brighton, CO 80601 `g h Gdn��l cop 8 b(o D 1 <br /> Phone Number: (720)523-6841 U <br /> So3 -�03� - goi3 <br /> Fax Number: (720)523-6998 �-3-� _ I Dl S <br /> 3D 3 - <br /> Email Address: Jrutter@adcogov.org <br /> �C csur(5110�@ Gld Gc v, o <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 /> 12 IS 1� <br /> Signal of Pe itt a Cor orate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />