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Page 5 of 5 <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: Matt Carnahan <br /> Permittee Company: Oldcastle SW Group, Inc.dba <br /> Four Corners Materials <br /> Address: P.O.Box 1969 <br /> Bayfield,CO 81122-1969 <br /> Phone Number: (970)247-2172 <br /> Fax Number: <br /> Email Address: ' <br /> r11C.airriak /1 m 4cov-\e rs Iv,2ferl�(5 . com <br /> Permitting Contact: Matt Carnahan <br /> Company: Oldcastle SW Group, Inc. dba <br /> Four Corners Materials <br /> Address: 6699 County Rd. 521 <br /> P.O.Box 1969 <br /> Bayfield, CO 81122 <br /> Phone Number: (970)247-2172 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Matt Carnahan <br /> Company: Oldcastle SW Group,Inc. dba <br /> Four Corners Materials <br /> Address: 6699 County Rd. 521 <br /> P.O.Box 1969 <br /> Bayfield,CO 81122 <br /> Phone Number: (970)247-2172 <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 /> �SoLUrGG' G;-►Yi�ronmc'1f>f I\N vl. 66 v9 2017 <br /> Signature of PerEittee,Cor orate Officer,Owner,or Documented Desiiznee Date <br /> M-AF-01 <br />