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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: Thomas M.Eve <br /> Permittee Company: Butala Construction Company <br /> Address: 9000 CR 152 <br /> P.O.Box 907 <br /> Salida,CO 81201-9519 <br /> Phone Number: (719)539-2521 <br /> Fax Number: (719)539-2523 <br /> Email Address: <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 /> 11L Zz /C <br /> Signature of Perniitlee, Corporate Officer,Owner,or Documented Designee D to <br /> M-AF-01 <br />