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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: Stephanie and Ray Sikes <br /> Permittee Company: Carrizo Stone, LLC <br /> Address: 1425 County Road Q <br /> Pritchett,CO 81064 <br /> Phone Number: (719) 643-5325 <br /> Fax Number: (719)643-5327 <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 /> Signature o Permittee,Corporate Office wner,or Documente esignee Date <br /> M-AF-0 1 <br />