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r e <br />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 />TomSmith <br />Permittee Company: <br />Rocky Mountain Materials & <br />Asphalt, Inc. <br />Address: <br />1910 Rand Ave <br />Colorado Springs, CO80906 <br />Phone Number: <br />(719) 473-3100 <br />Fax Number: <br />(719) 473-3109 <br />Email Address: <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 ofPermittee, Corporate Officer, Owner, or Documented Designee <br />M -AF -01 <br />�7- <br />Date <br />