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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 />Patrick Sullivan <br />Permittee Company: <br />Rio Grande County <br />Address: <br />168 N. Washington <br />Monte Vista, CO 81144 <br />Phone Number: <br />(719) 852-4781 VO <br />Fax Number: <br />(719) 852-0305 <br />Email Address: <br />)Mcroaddept@riograndecounty.org <br />I, the under ' e , I-elyby state that the information provided in this report is true and accurate, and that site operations are <br />being c ducted in ac ordance with the Division approved mining and reclamation plans. <br />of Permittee, Corporate Officer, Owner, or Documented Designee Date <br />M -AF -04 <br />