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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: Jordan Sasser <br /> Permittee Company: Fremont Paving&Redi-Mix, <br /> Inc. <br /> Address: P.O.Box 841 <br /> Canon City,CO 81215 <br /> Phone Number: (719)275-3264 <br /> Fax Number: (719)275-8897 <br /> Email Address: Jordan@arycorp.com S `Q <br /> I,the undersigned, eby state that the information provided in this report is true and accurate, and that site operations are <br /> be' g c ct 'n c rdance with the Division approved mining and reclamation plans. <br /> 7 <br /> , &0 <br /> Sign ur o mittee, Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-OI <br />