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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: Abe Vasquez <br /> Permittee Company: Hector Rodriguez <br /> Address: P.O. Box 122 <br /> Lyons, CO 80540 <br /> Phone Number: (303)823-6116 <br /> Fax Number: (303)823-6888 <br /> Email Address: <br /> Permitting Contact: Hector Rodriguez <br /> Company: Hector Rodriquez <br /> Address: P.O. Box 1504 <br /> Lyons,CO 80540 <br /> Phone Number: (303)823-6452 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Hector Rodriguez <br /> Company: Hector Rodriquez <br /> Address: P.O. Box 1504 <br /> Lyons, CO 80540 <br /> Phone Number: (303) 823-6452 <br /> Fax Number: <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 /> 7�� dr)AV\(kc�", " S� I ./ <br /> Signa(ure,,A Permittee,Corporate QVhcer,Owner,or Documented Designee Date <br /> M-AF-01 <br />