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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: Pat Palmer <br /> Permittee Company: Palmer Pipe&Construction, <br /> LLC <br /> Address: 381 Ute Junction Circle <br /> Durango,CO 81303 <br /> Phone Number: (970)946-5920 <br /> Fax Number: <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 rd ce wit the Division approved mining and reclamation plans. <br /> , ' <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />