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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: 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 /> Permitting Contact: Fred Olme <br /> Company: Rio Grande County <br /> Address: P.O.Box 46 <br /> Monte Vista, CO 81144 <br /> Phone Number: (719)852-4781 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Fred Olme <br /> Company: Rio Grande County <br /> Address: P.O.Box 46 <br /> Monte Vista, CO 81144 <br /> Phone Number: (719)852-4781 <br /> Fax Number: <br /> Email Address: <br /> 1,the undersigned,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> being co d in accordance with the Division approved mining and reclamation plans. <br /> Sig ure of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />