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r � <br /> 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: Abe Vasquez <br /> Permittee Company: Blue Mountain Stone <br /> Address: 4168 Ute Hwy <br /> Longmont, CO 80503 <br /> Phone Number: (303) 823-9625 <br /> Fax Number: (303) 823-6888 <br /> Email Address: <br /> 1,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 /> R - 2 - <br /> Sig ture rmittee Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-O 1 <br />