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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: Bradley S.Wilson <br /> Permittee Company: CEMEX, Inc. <br /> Address: PO Box 529 <br /> Lyons,CO 80540 <br /> Phone Number: (303)823-2100 <br /> Fax Number: (303)823-2199 <br /> Email Address: Bradleys.wilson@cemex.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 with the Division approved mining and reclamation plans. <br /> Signature offermittee.Cw,6orate(*nAr,Owner,or T)-,,-MPn7M eshin a Date <br />