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Page 5 of 5 <br /> Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have <br /> information on record). If this information is blank or not current,please type or print current contact information: <br /> Permittee Contact: Ralph Martinez <br /> Permittee Company: Southway Construction <br /> Company, Inc. <br /> Address: 117 White Pine Dr <br /> Alamosa, CO 81101 <br /> Phone Number: (719) 589-5103 <br /> Fax Number: (719) 589-5522 <br /> Email Address: SAFETY@Southwayco.com <br /> Permitting Contact: Izora Southway <br /> RaLf''A <br /> Company: Southway Construction <br /> Company, Inc. <br /> Address: 117 White Pine Dr <br /> Alamosa, CO 81101 <br /> Phone Number: (719)589-5103 <br /> Fax Number: <br /> 719--Y",✓/O3 <br /> Email Address: <br /> a�ZY '71VLU i <br /> Inspection Contact: Izora Southway <br /> Ra h 4 z, <br /> Company: Southway Construction <br /> Company, Inc. <br /> Address: 117 White Pine Dr <br /> Alamosa, CO 81101 <br /> Phone Number: (719) 589-5103 <br /> Fax Number: .7/9) SY <br /> Email Address: <br /> ly d so,,-II-kw rl <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 /> wl�tzl ksiv-- 16+ Q00 <br /> Signature of Per'miffeeLCorporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />