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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: Daniel Robinson <br /> Permittee Company: Robinson Sons Inc <br /> Address: 13600 CR 31.9 etasi -7 A-V1t <br /> Weston, CO 81091 c cj,-ACCi 81 <br /> Phone Number: (719)868-3625 tct 9--c-'Of A SS3Z <br /> Fax Number: (719)868-2163 -7 1 C1 f <br /> Email Address: <br /> :ham�15`�-ac G <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 /> Q�� — -'� —Je <br /> Signature of Permittee,Corporate Officer,Owner.or Documented Designee Date <br /> M-AF-01 <br />