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Page 5 of 5 <br /> Division records indicate the following permittee contact information. If this information is of current,please type or print <br /> current contact information: <br /> Permittee Contact: Matt Carnahan <br /> Permittee Company: Oldcastle SW Group,Inc. dba Four <br /> Corners Materials <br /> Address: P.O. Box 1969 <br /> Bayfield,CO 81122-1969 <br /> Phone Number: (970)247-2172 <br /> Fax Number: <br /> Email Address: Mcamahan@4comersmaterials.com <br /> 1,the undersigned,hereby state that the information provided in this report is true and acc ate,and that site operations are <br /> being conducted in ac rdance with the Division approved mining and reclamation plans. <br /> L LL 12 O° 1� <br /> Signature of Permittee,Cor orate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />