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f 5 <br />Division records indicate the following permittee contact information. If this information is not current lease pgsr print <br />current contact information: ' p npeor <br />Permittee Contact: I Roy Burtraw <br />Permittee Company <br />Address: <br />Southway Construction <br />Company, Inc. <br />117 White Pine Dr <br />Alamosa, CO 81101 <br />New contact Ralph Martinez <br />Phone Number: <br />(719) 589-5103 <br />Fax Number: <br />(719) 589-5522 <br />Email Address: <br />Safety@southwayco.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 />Owner, or Documented Designee <br />M -AF -01 <br />Date <br />