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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: Denise Gonzales /► <br /> Permittee Company: Hard Rock Paving and Redi- <br /> Mix, Inc. <br /> Address: P.O.Box 37 <br /> Salida,CO 81201 <br /> Phone Number: (719)275-1280 <br /> Fax Number: (719)275-8898 <br /> Email Address: <br /> �At C�111 a U t ar p 0-ovv-, <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 of Pe rite ner,or Documented Designee Date <br /> M-AF-01 <br />