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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: Adrian A.Absmeier <br /> Permittee Company: Absmeier Landscaping& <br /> Construction,LLC <br /> Address: 1424 21 st Street <br /> P.O. Box 1134 <br /> Alamosa, CO 81101 <br /> Phone Number: (719) 589-6994 <br /> Fax Number: (719) 587-0495 <br /> Email Address: Abshawneel2@yahoo.com <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 /> La4� 10 - 2 - 16 <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />