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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: Robert D. Oman e 5 re r <br /> Permittee Company: Select Materials, LLC L;m i tPW <br /> Address: P.O. Box 280 fO �Q X 7 y <br /> Fort Lupton, CO 80621 f I r f CC ��,2, <br /> Phone Number: (303) 857-4688 <br /> Fax Number: (303) 857-4638 <br /> Email Address: Bob@selectmaterials.net <br /> O#i hit <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 of Permittee, Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />