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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: Jodi Ricker <br /> SAe- v� <br /> Permittee Company: Fremont Paving&Redi-Mix, <br /> Inc. <br /> Address: 839 MacKenzie Avenue <br /> P.O. Box 841 <br /> Canon City,CO 81215 <br /> Phone Number: (719)275-1280 <br /> Fax Number: (719)275-8897 <br /> Email Address: Jodi@arycorp.com <br /> I,the undersigned,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> being c ted in accor=the proved mining and reclamation plans. <br /> )el'� jk'�'V'k- k:�k— <br /> Signatur o Permitte orate Rice wner,or Documented Designee Date <br /> M-AF-01 <br />