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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: Gale Swafford <br /> Permittee Company: George F. Gallegos <br /> Address: P.O. Box 575 <br /> Romeo, CO 81148 <br /> Phone Number: (179) 588-5113 <br /> Fax Number: <br /> Email Address: Gswafford@northconejos.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 /> )n� - &L�t&4 - --T' <br /> Signatu of Permi e, fora a Of r,Owner,or umented Designee 4Date <br /> M-AF-0I <br />