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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: Gerald Korinek <br /> Permittee Company: Korinek Sand&Gravel <br /> Address: 640 Lane 15 <br /> Manzanola,CO 81058 <br /> Phone Number: (719)469-6510 <br /> Fax Number: <br /> Email Address: Korineksand@gmail.com <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 /> e — - /-n -&,� <br /> Gv'�1,E o�021°2©14 <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />