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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: Apthon " aar Izal�"IYIi1lgr <br /> 11Y1S�i►1P �f't2. <br /> Permittee Company: Lafarge West, Inc. c/o Lafarge <br /> North America Inc. <br /> Address: ., <br /> 300- <br /> (-rcl ien , Co 3c,)40 f <br /> Phone Number: - <br /> Fax Number: <br /> Email Address: <br /> (.y,hoi5fi�`�. FF'1z� 1Ct�Czi Y��►C ur1.c'Gr1'1 <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 accoWL— _ with the Division approved mining and reclamation plans. <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />