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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 />Jordan Sasser <br />SC\"e�6cv <br />Permittee Company: <br />Hard Rock Paving and Redi- <br />Mix, Inc. <br />Address: <br />P.O. Box 841 <br />Canon City, CO 81215 <br />Phone Number: <br />(71) 927-5234 <br />-119 -02 75-3,,ju q, <br />Fax Number: <br />(719) 275-8897 <br />Email Address: <br />Jordan@arycorp.com <br />3 ods eQ"' rP . co w, <br />I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are <br />being conducte in7accordance with the Division approved mining and reclamation plans. <br />-7l 3� <br />Owner, or Documented Designee Date <br />M -AF -01 <br />