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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: James S.Miner <br /> Permittee Company: Builder's Aggregate, Inc. <br /> Address: 510 Dahlia St. <br /> Fort Morgan, CO 80701 <br /> Phone Number: (970)867-6334 <br /> Fax Number: (970)542-0832 <br /> Email Address: <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 /> ,Y r �- i <br /> YOature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />