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08/31/2016 10:17 7195895522 SOUTHWAY CONST CO PAGE 05/08 <br /> Division records indicate the following" Page 5 of <br /> permittee contact information. If this i formation is not cctrrettt,please type or print <br /> cu�r�:nt contact information: <br /> Permittee Contact: Roy$urtraw <br /> New coma t RaI h ll !� <br /> 1'ermittee Com y artxnez <br /> ,P�Y� Southwa Constriction <br /> Com an Inc. <br /> Address: 117 White pine Dr <br /> Alamosa,Co 81101 <br /> Phone Number: (719)589-5103 <br /> Fax Number: (719)589-5522 <br /> Entail Address: Safcty@southwayco.com <br /> 1,the undersigned,hereby state that the information provided in this report is tr e and accurate,and that site operations are <br /> being conducted in accordance with the Division approved mining and reclama -on plans. <br /> Signature o Ferimitt C gate Q££icer,Owner,or Documented D I..; -Date <br /> M-AF43 <br />