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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: Randal Arredondo <br /> Permittee Company: Saguache County <br /> Address: P.O.Box 476 <br /> Saguache,CO 81149 <br /> Phone Number: (719)655-2554 <br /> Fax Number: (719) 655-2543 <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 /> bei ducted in . ordance with the Division approved mining and reclamation plans. <br /> 7S: 2Q <br /> Si ature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />