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Page 5 of5 <br /> -Division recor4s indicate_the following p rw tt 11andowner- tirSo tion-(bian_A & ratet#3ataA-n pea_ligvP <br /> informational record). If this information is blank or not current,please type or print current contact informati <br /> inefilnl elCfl ia inn ma¢cyiaz i , 3 <br /> i <br /> 'Pem:iltteeton: y: i'Pa cersontonsttadecon,is - <br /> Address: 710 S. 15th St <br /> Grand Junction,CO 81501 <br /> Phone Number: (970)242-8134 <br /> Fax Number: (970)242-8977 <br /> Email Address: <br /> Permitting Contact: Alan Parkerson <br /> Company: Parkerson Construction,Inc. <br /> Address: 710 S. 15th St <br /> Grand Junction, CO 81501 <br /> Phone Number: (970)242-8134 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Alan ParkersonC <br /> JON Uel C.C� <br /> Company: Parkerson Construction,Inc. <br /> Address: 710 S. 15th St <br /> Grand Junction,CO 81501 <br /> Phone Number: (970)242-8134 (q-o) Z A7- -. q 0 , / <br /> Fax Number: v <br /> Email Address: <br /> I,the undersigned,bereiby state that the formation provided in this report is true and accurate, and that site operations are <br /> being conducted itis acciordalIce with the Divisi4 approved mining and reclamation plans. <br /> /, <br /> , ,,/,/, , L L....:, <br /> Signature of Perm' e‘c or'orate I ce G wner,or Documented Designee Date <br /> M-AF-01 <br />