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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 <br /> 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: - - ---- —-- -------- — - <br /> (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 81 152 <br /> Phone Number: (719)672-3372 -l3T <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 /> -- - ----- ---------- -- — <br /> Phone Number: (719)672-3372 <br /> Fax :Number: <br /> Email Address: <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 /> Signature of Permittee Cur orate ' er, 4vner,or Documented Designee Date <br /> nt-ar-iu <br />