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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 />Matt Carnahan <br />Permittee Company: <br />Oldcastle SW Group, Inc. dba Four <br />Corners Materials <br />Address: <br />P.O. Box 1969 <br />Bayfield, CO 81122-1969 <br />Phone Number: <br />(970) 247-2172 <br />Fax Number: <br />(970) 259-3631 <br />Email Address: <br />Mcarnahan@4cornersmaterials.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 accor.. nce with the Division approved mining and reclamation plans. <br />11 / i 2/Zo 15 <br />Signature of Permittee Corporate Officer, Owner or Documented Designee Date <br />M -AF -01 <br />