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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: Matt R.Carnahan <br /> Permittee Company: Oldcastle SW Group, Inc.dba Four <br /> Corners Materials <br /> Address: P.O. Box 1969 <br /> Bayfield,CO 8 1 1 22-1 969 <br /> Phone Number: (970)247-2172 <br /> Fax Number: (970)259-3631 <br /> Email Address: Mcamahan�-i;4cornersmaterials.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 a ordance with the Division approved mining and reclamation plans. <br /> IU Z-5 go/6 <br /> Signature of Pern ttee,Corporate Officer,Owner,or Documented Designee Date <br />