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Page 5 of 5 <br /> <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 /> <br />Permittee Contact: <br /> <br />Jason Burkey <br />Permittee Company: <br /> <br />Oldcastle SW Group, Inc. dba <br />Telluride Gravel <br /> <br />Address: <br /> <br /> <br /> <br />P.O. Box 3609 <br />Grand Junction, CO 81502 <br /> <br />Phone Number: <br /> <br />(970) 243-4900 <br />Fax Number: (970) 243-5945 <br />Email Address: Jburkey@oldcastlematerials.com <br />Permitting Contact: <br /> <br />Greg Homan <br />Company: <br /> <br />Oldcastle SW Group, Inc. dba <br />Telluride Gravel <br /> <br />Address: <br /> <br /> <br /> <br />Drawer U <br />Cortez, CO 81321 <br /> <br />Phone Number: <br /> <br />(970) 728-3775 <br />Fax Number: (970) 728-3015 <br />Email Address: <br />Inspection Contact: <br /> <br />Greg Homan <br />Company: <br /> <br />Oldcastle SW Group, Inc. dba <br />Telluride Gravel <br /> <br />Address: <br /> <br /> <br /> <br />270 Highway 625 <br />Telluride, CO 81321 <br /> <br />Phone Number: <br /> <br />(970) 728-3775 <br />Fax Number: (970) 728-3015 <br />Email Address: <br /> <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 /> <br /> <br /> <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date <br />M-AF-01