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Page 5 of 5 <br />Division records indicate the following pennittee contact information. If this information is not current, please type or <br />print current contact information: <br />Permittee Contact: <br />BradleyS. Wilson <br />Permittee Company: <br />CEMEX <br />Address: <br />PO Box 529 <br />Lyons, Co80540 <br />Phone Number: <br />(303) 823-2100 <br />Fax Number: <br />(303) 823-2199 <br />Email Address: <br />Bradleys.wilson@cemex.com <br />I, the undersigned, hereby state that the,—lonnation provided in this report is true and accurate, and that site operations are <br />- <br />being condy ccordance with Op Division approveq mining and reclamation plans. <br />or Documented DesiEnee <br />,M -AF -01 <br />�-Y-a�► <br />Date <br />