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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: Bill Tezak <br /> Permittee Company: Colorado Quarries Inc <br /> Address: 270 S 15th St <br /> Canon City, CO 81212 <br /> Phone Number: (719)275-6894 <br /> Fax Number: (719)275-2131 <br /> Email Address: Cquarries@qwestoffice.net <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 cordance with the Division approved mining and reclamation plans. <br /> ig ture o Peri itte or orate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />