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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: Delmer R. Rodarmel Sh e ; lq ' od a r rne L <br />Permittee Company: Florence Sand & Gravel <br />Address: 799 5th St <br />Penrose, CO 81240 <br />Phone Number: 719) 372-6025 <br />Fax Number: 719) 372-6922 <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 Division approved mining and reclamation plans. <br />WOER.. <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee <br />M -AF -01 <br />71:2g= <br />Date