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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: John Miner <br /> Permittee Company: Douglas County Sand&Gravel, <br /> LLC <br /> Address: P.O.Box 966 <br /> Castle Rock,CO 80104 <br /> Phone Number: (303)681-2696 <br /> _ � 737�4 <br /> Fax Number: (303) 681-0320 <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 /> '04/W A4,V-- <br /> Signature Permittee,Corporate Officer,Owner,or Documented Desiinee Date <br /> M-AF-01 <br />