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Agreement to Conduct Permitting by Electronic Means <br />Name of permittee representative desiring to <br />opt in to ePermit: <br />Title: <br />Name of permittee: <br />Signature: <br />ePermitting Administrator (if different from <br />representative signing agreement) <br />Email Address for ePermit Account: <br />0y"IFxf19 <br />Jason Burkey <br />Environmental/Resource Manager <br />Oldcastle SW Group, Inc- dba United Companies <br />Peter Siegmund <br />jburkey@oldcastlematerials com <br />Notarized Affidavit of Signature <br />Colorado <br />COUNTY OF: } ss. <br />Mesa <br />The foregoing instrument was acknowledged <br />before me this 10 YA day of 2017 by <br />(date) (month) (year) <br />as <br />Jason Burkey <br />(Name of permittee representative) <br />GENEVIEvem. BLECHA <br />NOTARY -PUBLIC <br />STATE OF COLORADO <br />NOTARY ID #19914003259 <br />M Commission Ex ares rel 4, 201 0 <br />(seal) <br />My Commission expires: <br />of <br />Environmental/Resource Manager <br />(title) <br />Oldcastle SW Group, Inc. dba United Companies <br />(permittee) <br />Page 3 of <br />NOTARY PUBLIC <br />