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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: ✓ <br /> _,_/o G �d rna�•� <br /> Permittee Company: Ready Mixed Concrete <br /> Company <br /> Address: ?7? /-�� S Z <br /> n,60 80601 Gu�{�.�, CO 906 Z/ <br /> Phone Number: 3}659.9638 -7 t a) 3 X yb <br /> Fax Number: "^""" '"r' <br /> Email Address: . <br /> j a . /d wl'14ha n &J T l. Co <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 /> 9Z/6 <br /> Sip8t0re of PtrUMM rDOrStOr Owner,or Documented Desianee Date <br /> M.AF-01 <br />