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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: Scott R.Brennise <br /> Permittee Company: 4B Land&Livestock LLC <br /> Address: 5801 Highway 394 <br /> Craig,CO 81625 <br /> Phone Number: (970)824-4767 <br /> Fax Number: <br /> Email Address: <br /> Permitting Contact: Sheila Brennise <br /> Company: 4B Land&Livestock LLC <br /> Address: 5801 HWY 394 <br /> Craig,CO 81625 <br /> Phone Number: (970)629-1396 <br /> Fax Number: <br /> Email Address: Dnr_drmsminadmin@state.co.us <br /> Inspection Contact: Jon Mueller <br /> SCeit k . ,LsecN"Ivies-- <br /> Company: 4B Land&Livestock LLC <br /> Address: 556 Struthers Ave. G eC?l l{w/ 34 <br /> Grand Junction,CO 81501- �� �;i Z <br /> 3826 C' ' <br /> Phone Number: (970)824-4767-vv.— <br /> Fax <br /> 24-4767Fax Number: <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,Aivision approved mining and reclamation plans. <br /> (72-101/47aSignatu of P mittee, or ra I fficer,Owner,or Documented Designee Date <br /> M-AF-G1 <br />