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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 />Andre Laroche <br />Permittee Company <br />Continental Materials <br />Corporation <br />Address: <br />.444 E. Costilla Si. , <br />Colorado Springs, CO 80903 <br />Phone Number: <br />(719) 475-0700 <br />Fax Number: <br />(719) 475-0226 , <br />Email Address: _ _ <br />Andre laroche@,.transitmix.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 accordanpe with the Division approved mining and reclamation plans. <br />AF -01 <br />-14 <br />ture of Permittee. Corporate Officer, Owner or Documented Designee <br />d e.4 -N'5) 7017 <br />Date <br />