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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 /> Permittee Company: Fremont Paving&Redi-Mix, <br /> Inc. <br /> Address: 839 MacKenzie Avenue <br /> Canon City,CO 81212 <br /> Phone Number: (719)275-1280 <br /> Fax Number: <br /> Email Address: Jodi@arycorp.com <br /> C, v� <br /> I,the dersigned,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> bein co ucted in accord ce with the Division approved mining and reclamation plans. <br /> c- tlb1.L 1� -Zvi <br /> Signat a oftle4mt0Z Corporate O ,Owner,or Documented Designee Date <br /> M-AF-01 <br />