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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: Doug Dowling <br /> Permittee Company: Dorn Ready Mix Corp. <br /> Address: 19671 Rd R 7 <br /> P.O. Box 636 <br /> Fort Morgan, CO 80701 <br /> Phone Number: (970) 867-2968 <br /> Fax Number: (970) 867-7443 <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 i ccordance with t Division approved mining and reclamation plans. <br /> Signat a of Peimittee Cor or Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />