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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: Jason Burkey <br /> Permittee Company: Oldcastle SW Group, Inc. dba <br /> United Companies of Mesa <br /> County <br /> Address: P.O. Box 3609 <br /> Grand Junction,CO 81502- <br /> 3609 <br /> Phone Number: (970)243-4900 <br /> Fax Number: <br /> Email Address: Jburkey ci oldcastlematerials.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 /> Signature of Per ittee Coro to Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />