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Page 5of5 <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: Matt Carnahan <br /> Permittee Company: Oldcastle SW Group,Inc.dba <br /> Four Corners Materials <br /> Address: P.O.Box 1969 <br /> Bayfield,CO 81122-1969 <br /> Phone Number: (970)247-2172 <br /> Fax Number: <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 accord ce with the Division approved mining and reclamation plans. <br /> p__ 12-esouRc S 6.111(904 k/1e7-tT4L nv1612 Ob/o4)7 I <br /> Signature of Permitte Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />