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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: Ferd& Matt Mueller <br /> Permittee Company: Siloam Stone, Inc. <br /> Address: 315 N. 7th St. <br /> Canon City,CO 81212 <br /> Phone Number: (719)275-4275 <br /> Fax Number: (719)275-9050 <br /> Email Address: Siloam(r,)ris.net <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 /> Sig ature o ermittee,Coroorate Officer,Owner,or Documented Designee Date <br />