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Page 5 of 6 <br /> Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have <br /> information on record). If this information is blank or not current,please type or print current contact information: <br /> Permittee Contact: Jason Burkey <br /> Permittee Company: Oldcastle SW Group, Inc. dba <br /> United Companies of Mesa <br /> Count <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@oldcastlematerials.com <br /> Permitting Contact: Pete Siegmund <br /> Company: Oldcastle SW Group,Inc. dba <br /> United Campanies of Mesa <br /> Count <br /> Address: 2273 River Road <br /> P.O.Box 3609 <br /> Grand Junction,CO 81502 <br /> Phone Number: (970)243-4900 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Pete Siegmund <br /> Company: Oldcastle SW Group, Inc. dba <br /> United Companies of Mesa <br /> Count <br /> Address: 2273 River Road <br /> P.O. Box 3609 <br /> Grand Junction, Co 81502 <br /> Phone Number: (970)243-4900 <br /> Fax Number: <br /> Email Address: <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 /> 11407 .0/7 <br /> Signature of PermKfee,Coro ate Officer,Owner,or Documented Designee Date <br />