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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: Kathy Stone <br /> Permittee Company: Stone Sand&Graved,LLC <br /> Address: P.O. Box 1568 <br /> Cortez, CO 81321 <br /> Phone Number: (970)882-3399 <br /> Fax Number: (970)882-3395 <br /> Email Address: Dkstone@outlook.com <br /> Permitting Contact: Kathy Stone <br /> Company: Stone Sand&Gravel,LLC <br /> Address: P.O. Box 1568 <br /> Cortez, CO 81321 <br /> Phone Number: - C:7\ <br /> Fax Number: <br /> Email Address: Dkstone@outlook.com <br /> Inspection Contact: Kathy Stone <br /> Company: Stone Sand&Gravel,LLC <br /> Address: P.O. Box 1568 <br /> Cortez,CO 81321 <br /> Phone Number: - CT-1 <br /> Fax Number: c�cb, �- S ✓ <br /> Email Address: C�K <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,6riporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />