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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 />Permittee Company: <br />Address: <br />Phone Number: <br />Fax Number: <br />Email Address: <br />Dan P. Conrad <br />pian e oon/R�DO <br />Meeker Sand & Gravel, Inc. <br />3251 RBC #4 <br />P.O. Box 1550 <br />Meeker, CO 81641 <br />(970) 878-3671 <br />(970) 878-5061 <br />Dan@msgreadymix.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 con d cted incordance with the Division approved mining and reclamation plans. <br />/4& - <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee <br />M -AF -01 <br />4-41-/6 <br />Date <br />