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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: <br />Bill Tezak <br />Permittee Company: <br />Colorado Quarries Inc <br />Address: <br />270 S 15th St <br />Canon City, CO 81212 <br />Phone Number: <br />(719) 275-6894 <br />Fax Number: <br />(719) 275-2131 <br />Email Address: <br />Cquarries@qwestoffice.net <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 accorda e with the Division approved mining and reclamation plans. <br />Si at e of P : rmittee 1 or ! i ra <br />w <br />M -AF -0 1 <br />ficer, 1 wner, or Documented Designee <br />Date <br />