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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: Kathy Stone <br /> Permittee Company: Stone Sand&Gravel,LLC <br /> Address: P.O.Box 1568 <br /> Cortez,CO 81321 <br /> Phone Number: (970)882-3399 <br /> Fax Number: (970)882-3395 <br /> Email Address: Dkstone@outlook.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 /> z. "X A -- - <br /> Signature of P rmittee. raorate Officer.Owner,or Documented Desienee Date <br />