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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: Christine Tortorice <br /> Permittee Company: Larry and Christine Tortorice <br /> Address: 17512 County Road 83 <br /> Trinidad, CO 81082 <br /> Phone Number: (719) 846-2333 <br /> Fax Number: <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 /> �) 14) <br /> Si ature f ittee Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />