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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 <br /> print current contact information: <br /> Permittee Contact: Robert S. Scott <br /> Permittee Company: Canyon Sand&Gravel <br /> Address: P.O.Box 1743 <br /> Pagosa Springs,CO 81147- <br /> 1743 <br /> Phone Number: (970)731-4707 <br /> Fax Number- (97$)_7� <br /> Email Address: Snowangel(a�dishmail.net ,® ,�,� �l�,��} A <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 /> Sign ture of Permittee,Corporate Officer,Owner.or Documented Designee date' <br /> M-AY-oi <br />