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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: Matt Mueller <br /> Permittee Company: Siloam Stone,Inc. <br /> Address: 315 N. 7th St. <br /> Canon City,CO 81212 <br /> Phone Number: (719)2754275 <br /> Fax Number: (719)2691O3,3-a��-90�0 <br /> Email Address: Siloam@siloamstone.com <br /> Permitting Contact: Steven O'Brian <br /> Company: Environment,Inc. <br /> Address: 7985 Vance Dr Ste 205A <br /> Arvada,CO 80003 <br /> Phone Number: (303)423-7297 <br /> Fax Number: (303)423-7599 <br /> Email Address: <br /> Inspection Contact: -NMd-h4"eHef <br /> Matt Mueller <br /> Company: Siloam Stone <br /> Address: 1360 Rudd Ave <br /> Canon City,CO 81212 <br /> Phone Number: (719)275-4275 <br /> Fax Number: (719)�a7�•-�O�j T/ <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 /> Signalfurie of Per ttee Cor orate Officer,Owner,or Documented Designee Date <br /> M-A}-01 <br />