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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 />Abe Vasquez <br />Permittee Company: <br />Hector Rodriguez <br />Address: <br />P.O. Box 122 <br />Lyons, CO 80540 <br />Phone Number: <br />(303) 823-6116 <br />Fax Number: <br />(303) 82376888 <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 />S <br />M -AF -01 <br />Owner, or Documented Designee <br />' 2 /1._ <br />Date <br />