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Page 5 of 5 <br />Division records indicate the following permittee contact information. If this information is not current, please type or <br />print current contact information: <br />Permittee Contact: <br />Gale Swafford <br />Permittee Company: <br />George F. Gallegosr <br />Address: <br />P.O. Box 575 <br />Romeo, CO 81148 <br />Phone Number: <br />(179) 588-5113C119)0 <br />Fax Number: <br />Email Address: <br />Gswafford@northconejos.com <br />SW <br />I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are <br />bein conducted in accordance with the Division approved mining and reclamation plans. <br />S ature of Per tee, torpo a -Officer, Own r, r Documented Designee Date <br />M -AF -01 <br />