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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 />Ralph Bell <br />Permittee Company: <br />Castle Rock Construction <br />Company of Colorado, LLC <br />Address: <br />6374 S. Racine Circle <br />Centennial, CO 80111 <br />Phone Number: <br />(303) 688-6611 <br />Fax Number: <br />(303) 688-6299 <br />Email Address: <br />je13eGG a) CZ L.e...t. 1 <br />CO 041' <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 />3/G /!G <br />Signature of Perfnittee, Corporate Officer, Owner, or Documented Designee Date <br />M -AF -01 <br />