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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 print <br />current contact information: <br />Permittee Contact: Michael B. Toelle <br />Permittee Company: Holcim (US) Inc. <br />Address: 3500 Highway 120 <br />Florence, CO 81226 <br />Phone Number: 119)-454--t4lD2 <br />L 9) -Z :88 <br />Fax Number: 719) 784-3470 <br />Email Address: Mike.toelle@holcim.com <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 />of Permittee, Corporate Officer, <br />M -AF -01 <br />or Documented Designee <br />Z 045 <br />Date