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Page 5of5 <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: Michael B.Toclle <br /> Et2✓LLlt-DETASE <br /> t <br /> Permittee Company: Holcim(US)Inc. <br /> Address: 3500 Highway 120 <br /> Florence,CO 81226 <br /> Phone Number: <br /> (717) - 141-23 <br /> Fax Number: ( ) 6 (7' ( ) 7-84/- 4 1 s. v, <br /> Email Address: \ <br /> dervi<x-clec,sela ncellolutt. col ./ <br /> Permitting Contact: Tom Newman <br /> Company: Holcim(US)Inc. <br /> Address: 1405 Parkwood Dr <br /> Fort Collins,CO 80525 <br /> Phone Number: 65 <br /> �� e (quo, Z15 -6116 <br /> Fax Number: (970)482-1363 <br /> Email Address: <br /> Inspection Contact: Mickael B.-Peek -r ""--4 <br /> Company: Holcim(US)Inc. <br /> Address: 3500 Highway 120 <br /> Florence, CO 81226 <br /> Phone Number: ( - ( lq) Z 8 g - fti�3 <br /> Fax Number: - (-1V��,y _ &/ 1 s- <br /> Email Address: \ _I <br /> d eYi•cc k.deG,se�� l av�c ho/cia/. CAI iy <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 /> P>( , QssA. .ger , 1 o%/2.4117 <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />