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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: Julie Mikulas <br /> Permittee Company: Martin Marietta Materials, Inc. <br /> Address: 1800 N. Taft Hill Road <br /> Fort Collins,CO 80521 <br /> Phone Number: (970)227-4041 <br /> Fax Number: (970)407-3900 <br /> Email Address: Julie.mikulas@martinmarietta.com <br /> 1,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 /> %Yt"' z 0/-/Z <br /> Sigature of Permittee, Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />