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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: Brad 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: Bradf@Irmconcrete.com <br /> 1,the undersigned,hereby state t1wiffirie information provided in this report is true and accurate, and that site operations are <br /> being conduct d in accorda wit he Di n approved mining and reclamation plans. <br /> 7 <br /> / —� <br /> Si re of Permittee, Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />