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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: Gary Woodworth <br /> Permittee Company: The Gallegos Corporation <br /> Address: P.O.Box 821 <br /> Vail,CO 81658 <br /> Phone Number: (970)926-3737 <br /> Fax Number: (970)926-3727 <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 /> - /7 / <br /> S' atur f Permittee,Corporate Officer,Owner,or Documented Designee ate <br /> M-AF-01 <br />