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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 />IvanD. Geer <br />Permittee Company: <br />Grand Junction Concrete Pipe <br />Co. <br />Address: <br />556 Struthers Ave. <br />Grand Junction, C081505 <br />Phone Number: <br />(970) 242-5370 <br />Fax Number: <br />(970) 245-7716 <br />Email Address: <br />on Mo ell <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 />Signature ofj�ermittee, Corporate Officer, Owner, or Documented Designee <br />M -AF -01 <br />Date <br />