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Page 5 of 5 <br /> i <br /> Division records indicate the following permittee contact information. If this information is not current, please type or <br /> print current contact information: <br /> Permittee Contact: JoeKozimor <br /> Permittee Company: Consolidated Constructors, Inc. <br /> Address: P.O. Box 629 <br /> Farmington,NM87499 <br /> Phone Number: (505) 326-7771 <br /> Fax Number: (505) 326-7774 <br /> Email Address: <br /> 1,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 /> Signature ofKrmiVe, Corpor`a!40fjiceo,Owner,or Documented Designee Date <br /> M-AF-01 <br />