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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 />Eleuto J. Rivera <br />Permittee Company: <br />Rivera's Excavation <br />Address: <br />P.O. Box 24 <br />Amalia, NM 87512 <br />Phone Number: <br />(575) 586-1059 <br />Fax Number: <br />(575) 586-1059 <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 />t <br />M -AF -01 <br />�G�La/ <br />.----- <br />/ <br />r orate Officer <br />Owner, of Permittee, p or Documented Designee <br />