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Page 5 of 5 <br />Division records indicate the following permittee contact information. If this information is not current, please type or <br />print current contact information: <br />Permittee Contact: <br />MattR. Carnahan <br />Permittee Company: <br />Oldcastle SW Group, Inc. dba <br />Four Corners Materials <br />Address: <br />P.O. Box 1969 <br />Bayfield, C081122-1969 <br />Phone Number: <br />(970) 247-2172 <br />Fax Number: <br />(970) 259-3631 <br />Email Address: <br />rycOW'h a�ahQ�py n�S m���v�1�S C�YI <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 accordWce with the Division approved mining and reclamation plans. <br />Signature <br />M -AF -01 <br />Owner, or Documented Designee <br />07 2b SQ S <br />Date <br />