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M <br /> 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: Mark Johnson <br /> Permittee Company: Bestway Concrete Company <br /> Address: 301 Centennial Dr. <br /> Milliken, CO 80543 <br /> Phone Number: (970)587-7277 <br /> Fax Number: (970)587-7287 <br /> Email Address: Mjohnson@bestwayconcrete.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 /> Signature of Perm'Wee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />