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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: Ralph Bell <br /> Permittee Company: Castle Rock Construction <br /> Company of Colorado, LLC <br /> Address: 6374 S. Racine Circle <br /> Centennial, CO 80111 <br /> Phone Number: (303) 688-6611 <br /> Fax Number: (303)688-8885 <br /> Email Address: <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 /> 04 <br /> 7/11/16 <br /> Signature of Pormittee,Corporate Officer Owner,or Documented Designee Date <br />