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r <br /> 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: Jack E.Paulson <br /> Permittee Company: White River Aggregates,Inc. <br /> Address: 1107 E.Victory Way <br /> Craig,CO 81625 <br /> Phone Number: (970) 824-3187 <br /> Fax Number: (970) 824-4067 <br /> Email Address: <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 /> &' c ,AV'L s►n g/.P. S�, �i�v 4,�`iz/ZG <br /> Signature of PjKniitee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />