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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:�_.._' ".s--"- <br /> r3E-45e <br /> vy <br /> Permittee Company: Holcim(US)Inc. <br /> Address: 3500 Highway 120 <br /> Florence,CO 81226 <br /> Phone Number: (?4-9)-2•81-44-e (V/c-j) Zit _ {4!Z 3 <br /> Fax Number: (719)784-3470 C�/ S 1 z- �l j 815- <br /> Email Address: ` J <br /> deyNlti< .szlec‘se@ ��-a,�e1,w)t-btA ta'w✓ <br /> Permitting Contact: Tom Newman <br /> Company: Holcim(US)Inc. <br /> Address: 1405 Parkwood Dr <br /> Fort Collins,CO 80525 <br /> Phone Number: ( 5)482-5600 0,79)2.15--6//O ✓ <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: -D6735€ <br /> Company: Holcim(US)Inc. <br /> Address: 3500 Highway 120 <br /> Florence, CO 81226 <br /> Phone Number: (7-19)Mt-Mt (- i ) z1 -/i/2.3 <br /> Fax Number: (71-9)784-3470 (7/ 7.6 V_ (lie/ <br /> i s- <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 /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />