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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 print <br />current contact information: <br />Permittee Contact: <br />Adrian A. Absmeier <br />Permittee Company: <br />Absmeier Landscaping & <br />Construction, LLC <br />Address: <br />1424 21st Street <br />P.O. Box 1134 <br />Alamosa, CO 81101 <br />Phone Number: <br />(719) 589-6994 <br />Fax Number: <br />(719) 587-0495 <br />Email Address: <br />AbshawneeI2@yahoo.com <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 />Signature of Permittee, Corporate Officer, Owner, or Documented Designee <br />M -AF -01 <br />/0-4-45 <br />Date <br />