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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: Eleuto J.Rivera <br /> Permittee Company: Rivera's Excavation <br /> Address: P.O. Box 24 <br /> Amalia,NM 87512 <br /> Phone Number: (575) 586-1059 <br /> Fax Number: (575)586-1059 <br /> Email Address: <br /> Permitting Contact: Eleuto J.Rivera <br /> Company: Rivera's Excavation <br /> Address: P.O. Box 24 <br /> Amalia,NM 87512 <br /> Phone Number: (505)586-1059 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Eleuto J.Rivera <br /> Company: Rivera's Excavation <br /> Address: P.O. Box 24 <br /> Amalia,NM 87512 <br /> Phone Number: )586-1059 <br /> Fax Number: <br /> Email Address: <br /> ,-ems �� � � 0�:Ho0 k . C�oY <br /> 1,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 /> ,�L4. <br /> �Pc 13 ,�1;17 <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-0I <br />