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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: J er <br /> Permittee Company: Hard Rock Paving and Redi- <br /> Mix,Inc. <br /> Address: 839 Mackenzie Ave <br /> P.O.Box 165 <br /> Canon City,CO 81215 <br /> Phone Number: (719)275-1280 <br /> Fax Number: <br /> Email Address: <br /> I,the unders' ed,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> being cond ct d in accordance with the Division approved mining and reclamation plans. <br /> R4C�- <br /> F-eb?'Of4 <br /> Signature o er r rate O er,Owner,or Documented Designee Date <br /> M-AF-01 <br />