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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: Dan P.Conrado <br /> Permittee Company: Meeker Sand&Gravel,Inc. <br /> Address: 3251 RBC#4 <br /> P.O.Box 1550 <br /> Meeker,CO 81641 <br /> Phone Number: <br /> Fax Number: 9 l � <br /> Email Address: Dan@msgreadymix.com <br /> 1,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 /> ignature of Permittee,Corporate Offic ,Owner,or Documented Designee Date <br /> M-AF-01 <br />