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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: Jodi Ricker <br /> Permittee Company: Hard Rock Paving and Redi- <br /> Mix, Inc. <br /> Address: P.O.Box 165 <br /> Canon City, CO 81215 <br /> Phone Number: (719)275-3264 <br /> Fax Number: (719)275-8897 <br /> Email Address: Jodi@arycorp.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 /> 2c 16 <br /> Signature of P i or icer,Owner,or Documented Designee Date <br /> M-AF-01 <br />