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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: Richard F.Wyatt <br /> Permittee Company: Wyatt Redi-Mix Company <br /> Address: 690 Harrison Street <br /> P.O. Box 1052 <br /> Walden, CO 80480 <br /> Phone Number: (970) 723-4471 <br /> Fax Number: (970) 723-3222 <br /> Email Address: <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 w' e i ' ion approved mining and reclamation plans. <br /> Signature of Permittee C orate Officer,Owner,or Documented Designee #atc <br /> M-AF-01 <br />