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E 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: Gary Woodworth <br /> Permittee Company: The Gallegos Corpofation <br /> Address: P.O. Box 821 <br /> Vail, CO 81658 <br /> Phone Number: (970)926-3737 <br /> Fax Number: (970)926-3727 <br /> Email Address: qq <br /> Od�Otr�'�jo� SCOT• eoM <br /> Permitting Contact: William P.Balaz,Jr. <br /> Company: c <br /> Address: P-&.$urllte" 2?Sy Co"!r-S C.In%je, Sw 2`5 <br /> Graud.J et+e O-81502 �r & cc) 8 'so <br /> Phone Number: <br /> Fax Number: (WO)263"9336 q-7 0 Z.ql_ 31 Z& ✓ <br /> Email Address: bill- Ejd�ZeZ4 e- a 4-ecA r (XM <br /> Inspection Contact: William P.Balaz,Jr. �" <br /> Company: nc. -re4-V�T!'Gr'1 1!V G <br /> Address: P:�-$cJR' o 1 E-q Gvm,f0,SS 1r7 VV Z 6 S <br /> G 02 SZ to <br /> Phone Number: (� C�-70 " 91 rG — ?66 1 <br /> Fax Number: ( 63 6 q 7D 2-0 <br /> Email Address: i'/ Gt 2.d C� ,GO�(i1 <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 /> c r Owner or Documented Desi nee i!ale —L <br /> Wa4turfPermtttee,Corporate Officer,, g <br /> M-AF-01 <br />