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Agreement to Conduct Permitting by Electronic Means <br />Name ofpermittee representative desiring to <br />opt in to ePermit: <br />Title: <br />Name ofpermittee: <br />Signature: <br />ePermitting Administrator (if different from <br />representative signing agreement) <br />Email Address for ePermit Account: <br />STATE OF: <br />Colorado <br />Jason Burkey <br />Environmental/Resource Manager <br />Oldcastle Southwest Group, Inc. dba United Companies <br />Peter Siegmund <br />jburkey@oldcastlematerials.com <br />Notarized Affidavit of Signature <br />COUNTY OF: ) ss, <br />Mesa <br />The foregoing instrument was acknowledged <br />before me this <br />J6 day of Nli p iKLh✓y , 2016 by <br />(date) (month) (year) <br />as <br />Jason Burkey Environmental/Resource Manager <br />(Name of permittee representative) (title) <br />of <br />(seal) <br />My Commission expires: <br />961 4 0/9 <br />Oldcastle Southwest Group, Inc. dba United Companies <br />(permittee) <br />Page 3 of 6 <br />QAti24 , 7) Ada, <br />NOTARY PUBLIC <br />GENEVIEVE M. BLECHA 1 <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID #19914003259 <br />My Commission Expires April 4, 2019 <br />