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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: Patrick Sullivan <br /> Permittee Company: Rio Grande County <br /> Address: 168 N. Washington <br /> Monte Vista, CO 81144 <br /> Phone Number: (719)852-4781 <br /> Fax Number: (719) 852-0305 <br /> Email Address: Rgcroaddept@riograndecounty.org <br /> I,the undersigne reby state that the information provided in this report is true and accurate, and that site operations are <br /> being cond ed in ac rdance with the Division approved mining and reclamation plans. <br /> AI <br /> Signat of Permittee,Corporate Officer,Owner,or Documented Desilinee Date <br /> M-AF-04 <br />