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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 />Pennittee Contact: <br />Judy DeVincentis <br />Permittee Company: <br />Western Gravel, Inc. <br />Address: <br />3001 N. Townsend Ave. <br />Montrose, CO 81401 <br />Phone Number: <br />(970) 249-2431 <br />Fax Number: <br />(970) 249-0590 <br />Email Address: <br />Judy@westerngravel.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 />Signat <br />M -AF -01 <br />(1 c <br />orate Officer, Owner, or Documented Designee <br />Date <br />