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Page 5 of 5 <br /> Division records indicate the following pernuttee contact information. If this information is not current,please type or print <br /> current contact information: <br /> Permittee Contact: Michael B.Toelle <br /> Pem-ittee Company: Holcim(US)Inc. <br /> Address: 3500 Highway 120 <br /> Florence,CO 81226 <br /> Phone Number: (719)288-1402 <br /> Fax Number: (719)784-3470 <br /> Email Address: Mike.toelle@holcim.com <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 /> � � ld ZvIC <br /> Signature of Permittee,Corporate O icer,Owner,or Documented Designee Date <br /> M-AF-01 <br />