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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: M=-' ' ".T -'le <br /> 2Vr\rt cls 6D2c.s <br /> Permittee Company: Holcim(US)Inc. <br /> Address: 3500 Highway 120 <br /> Florence, CO 81226 <br /> Phone Number: - ( -/9) Zai E- t 4�3 V <br /> Fax Number: (7-f4)--784=-34-70 (-1-19) �e(1 „ I i s ✓ <br /> Email Address: �l <br /> Permitting Contact: Tom Newman <br /> Company: Holcim(US)Inc. <br /> Address: 1405 Parkwood Dr <br /> Fort Collins,CO 80525 <br /> Phone Number: (9-78)-4-8.2-&600 (C170 Zl - i/0 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Miehael-13-.---Teeffe <br /> cY}rcic <br /> Company: Holcim(US)Inc. <br /> Address: 3500 Highway 120 <br /> Florence,CO 81226 <br /> Phone Number: ( - (y./9) ave- /4/23 <br /> Fax Number: - (7) ) 7,e c_ Wir <br /> Email Address: \ J 7 <br /> deanrcck • clk554-te Ocokr./1.0` ,44.„0"17 <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 /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-0 1 <br />