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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 />Matt Mueller <br />Permittee Company: <br />Siloam Stone, Inc. <br />Address: <br />315 N. 7th St. <br />Canon City, CO 81212 <br />Phone Number: <br />(719) 275-4275 <br />Fax Number: <br />(719) 269-1033 <br />Email Address: <br />Si loam(asiloamstone.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 />Signature o Permittee, CorporateOfficer, Owner, or Documented Designee Date <br />See attached sheet for additional information <br />