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Page 5 of 5 <br /> Division records indicate the following permittee contact information. If this information is i iot current,please type or print <br /> current contact information: <br /> Permittee Contact: Michael D.Coleman <br /> Permittee Company: ACA Products, Inc. <br /> Address: <br /> P.O.Box 1887 <br /> Buena Vista,CO 81211 <br /> Phone Number: (719)395-3790 <br /> Fax Number: (719)395-3794 <br /> Email Address: Mcoleman@acaproducts.com <br /> 1,the undersigned,hereby state that the information provided in this report is true and accui ate,and that site operations are <br /> being conducted in accordance with the Division approved mining and reclamation plans. <br /> I6 W � (% - l 2 U$ z015 <br /> Signature of Permittee, Corporate Officer, Owner,or Documented Designee Date <br /> M-AF-01 <br />