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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: Louis K. Girodo <br /> Permittee Company: San Juan County <br /> Address: 1512 Greene St <br /> P.O. Box 466 <br /> Silverton, CO 81433 <br /> Phone Number: (970)387-9932 <br /> Fax Number: (970)387-5019 q7o fin. elm 3� <br /> Email Address: Xroads@outlook.com Sjr`r�����Ga,-llu,xt.t,v►,+ n- �j,�ad,, �a�r/�sc.���, <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 /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />