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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: Betty Holley <br /> Permittee Company: H&H Stone <br /> Address: P.O. Box 246 <br /> Dove Creek, CO 81324 <br /> Phone Number: (970)677-4190 <br /> Fax Number: (970)677-4190 <br /> Email Address: Andysbay@hotmail.com <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 /> A"i' ill // ,?s l � <br /> Signature of Permittee Cor orate Off er,Owner,or Documented Designee DAte <br /> M-AF-01 <br /> a � <br />