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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: Joe Kozimor <br /> Permittee Company: Consolidated Constructors,Inc. <br /> Address: P.O. Box 629 <br /> Farmington,NM 87499 <br /> Phone Number: (505)326-7771 <br /> Fax Number: (505)326-7774 <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 accor ance with the Division approved mining and reclamation plans. <br /> Sig to of Permit rate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />