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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 />Ronald L. Barrier <br />Permittee Company: <br />Ronald L Barrier <br />Address: <br />P.O. Box 3 <br />Alamosa, CO 81101 <br />Phone Number: <br />(719) 850-8500 <br />Fax Number: <br />(719) 587-0456 <br />Email Address: <br />Rmmp17@msn.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 />Q <br />Signre of Perjittee, Co , . orate Officer, Owner or Documented Designee <br />M -AF -01 <br />la -1 O S <br />Date <br />