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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: Debbie Wagner <br /> Permittee Company: High Plains Stone Company <br /> Address: P.O.Box 100 <br /> Castle Rock, CO 80104 <br /> Phone Number: (303)791-1862 <br /> Fax Number: (303)791-1919 <br /> Email Address: j f1 j h n S s+on e. co m <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 /> QJ'Lk� LO co- �- <br /> Signature of Permittee, Corp ate Officer, Owner,or Documented DesitInee Date <br /> M-AF-01 <br />