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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: Jason Burkey <br /> Permittee Company: Oldcastle SW Group, Inc. dba B <br /> & B Excavating <br /> Address: P.O. Box 3609 <br /> Grand Junction, CO 81502- <br /> 3609 <br /> Phone Number: (970)328-1734 <br /> Fax Number: (970)328-1735 <br /> Email Address: Jburkey@oldcastlematerials.com <br /> Permitting Contact: Jason Burkey <br /> Company: Oldcastle SW Group, Inc. d.b.a. <br /> B&B Excavating <br /> Address: P.O. Box 4870 <br /> Eagle, CO 81631 <br /> Phone Number: (970)328-1734 <br /> Fax Number: (970)328-1735 <br /> Email Address: <br /> Inspection Contact: Jason Burkey <br /> Company: Oldcastle SW Group, Inc. dba B <br /> &B Excavating <br /> Address: P.O. Box 4870 <br /> Eagle, CO 81631 <br /> Phone Number: (970)328-1734 <br /> Fax Number: (970)328-1735 <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 /> S11117 <br /> Signature of Per ittee,Co orate Officer,Owner,or Documented Desienee Date <br /> M-AF-01 <br />