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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: Tim DeHerrera <br /> Permittee Company: Alamosa County <br /> Address: 8663 S.CR 109 <br /> Alamosa, CO 81101 <br /> Phone Number: (719)589-6262 <br /> Fax Number: (719)589-6063 <br /> Email Address: Tdeherrera@alamosacounty.org <br /> Permitting Contact: a'rnri`:R* <br /> Company: Alamosa County <br /> Address: P.O. Box 178 <br /> Alamosa, CO 81101 <br /> Phone Number: (719)589-3841 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Phff-W"t l� <br /> T;'ti Joe '0 � r.,^01 i <br /> Company: Alamosa County <br /> Address: P.O. Box 178 <br /> Alamosa, CO 81101 <br /> Phone Number: (719)589-3841 <br /> Fax Number: <br /> Email Address: <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-04 <br />