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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: Frances A. Phillips <br /> Permittee Company: Phillips Stone Company, Inc. <br /> Address: 7850 Ute Hwy <br /> Longmont, CO 80503 <br /> Phone Number: (303) <br /> 4 q <br /> Fax Number: <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 with the Division approved mining and reclamation plans. <br /> Li <br /> Signature of Permittee Cor orate Officer, Owner,or Documented Designee Date <br /> NI-M-u 1 <br />