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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: John Gallegos <br /> Permittee Company: Telluride Stone Company Inc. <br /> Address: P.O. Box 3552 <br /> Telluride,CO 81435 <br /> Phone Number: (970) 728-6201 <br /> Fax Number: (970)369-4568 <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 /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> bf-AF-01 <br /> M-2011-013-2016 <br />