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Page 5 of5 <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 I <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: Frcd-Olmc 7 <br /> f ATTZ►t,IL I l)VA4 <br /> Company: Rio Grande County <br /> Address: –12:4207-Bcpr46— <br /> Monte Vista, CO 81144 ' <br /> itta.7X 14s)14 eo <br /> Phone Number: (719)852-4781 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: -Fred Ohne <br /> /Ark/L 0P.1 <br /> Company: Rio Grande County <br /> Address: .PSl.-i x-46- t✓ A) (A1,4Sflj, pz•. tel'% <br /> Monte Vista, CO 8H 44 <br /> A/10-v7 s J Co n i, i <br /> Phone Number: (719)852-4781 <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 /> /b✓ A <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-04 <br />