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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: Stephanie Fancher <br /> Permittee Company: Loveland Ready Mix Concrete, <br /> Inc. <br /> Address: P.O. Box 299 <br /> Loveland, CO 80539-0229 <br /> Phone Number: (970) 667-2680 <br /> Fax Number: (970) 667-0036 <br /> Email Address: Stephanieh@lrmconcrete.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 conducted in accordance i Division approved mining and reclamation plans. <br /> Signa ure of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />