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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: Trinidad Martinez Christopher Rodriguez <br /> Permittee Company: Costilla County <br /> Address: P.O. Box 130 <br /> San Luis,CO 81152 <br /> Phone Number: (719)937-7668 <br /> Fax Number: (800) 934-0342 <br /> Email Address: chris.rodrigez@costillacounty-co.gov <br /> Permitting Contact: Matthew Valdez Christopher Rodriguez <br /> Company: Costilla County <br /> Address: P.O. Box 100 <br /> San Luis,CO 81152 <br /> Phone Number: (719)672-3372 03-7- --�(eug <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Matthew Valdez <br /> Christopher Rodriguez <br /> Company: Costilla County <br /> Address: P.O. Box 100 <br /> San Luis, CO 81152 <br /> Phone Number: (719)672-3372 q3 -3(6-b <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 /> L�� fib /Z/1-/� <br /> Signature of Permittee Corporate Mer,bwner,or Documented Designee Date <br /> W A -0N <br />