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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: Sylvia S.Lopez <br /> Permittee Company: S &S Services <br /> Address: 19901 State Hwy. 12 <br /> Weston, CO 81091 <br /> Phone Number: (719)868-3307 <br /> Fax Number: (719)868-3004 <br /> Email Address: Lopersns@aol.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 /> 1§'ignatur ermittee Cor orate Officer wner, Documented Designee Date <br /> M A� <br />