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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: Randal H.Arredondo <br /> Permittee Company: Saguache County <br /> Address: P.O. Box 476 <br /> Saguache, CO 81149 <br /> Phone Number: (719)655-2554 <br /> Fax Number: (719)655-2543 <br /> Email Address: <br /> Permitting Contact: Steve L.Archuleta <br /> Company: Saguache County Road& <br /> Bridge <br /> Address: P.O. Box 655 <br /> Saguache, CO 81149 <br /> Phone Number: (719)655-2554 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: �t�, �` ✓ �� <br /> Company: Saguache County Road& <br /> Bridge <br /> Address: P.O. Box 655 <br /> Saguache, CO 81149 <br /> Phone Number: (719)655-2554 <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 /> bein ucted in accordance with the Division approved mining and reclamation plans. <br /> -� - - cY-r <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />