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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: Robert S. Scott <br /> Permittee Company: Canyon Sand&Gravel <br /> Address: P.O.Box 1743 <br /> Pagosa Springs, CO 81147- <br /> 1743 <br /> Phone Number: (970)731-4707 <br /> Fax Number: (970) 731-4707 <br /> Email Address: t Sn OLvdn y�I ra.�c:6i ��►�c i ] ( , C C�/YL <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 /> Signature of Permittee, Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br /> zdt t (vr ( ! C A e I(w-, �civitc�v�'-Z n,1 d <br /> 01/1 <br /> th �.. <br />