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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: <br /> ck '7064S€ <br /> Permittee Company: Holcim(US)Inc. <br /> Address: 3500 Highway 120 <br /> Florence, CO 81226 <br /> Phone Number: (74 9)255-1402 C7-I9) lie -A/23 <br /> Fax Number: (74.9)-48.4=t470 c719) ��c_ ['�/s <br /> Email Address: V`- 'l <br /> C4ev1.1c_t<aec ICAPN e hot gm.co14 <br /> Permitting Contact: Tom Newman V <br /> Company: Holcim(US)Inc. <br /> Address: 1405 Parkwood Dr <br /> Fort Collins, CO 80525 <br /> Phone Number: (949)-442-5600 (57 Z/S-4//O <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: <br /> -eYlrl 'Je-c•S-e v <br /> Company: Holcim(US)Inc. <br /> Address: 3500 Highway 120 <br /> Florence, CO 81226 <br /> Phone Number: (94-0)-2-$$-1-402 1Zvi;_ /yz 3 V <br /> Fax Number: (4÷9)-5184="3#51t 17./J 7-854'/8/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 /> Y._ `'r:C�.�`^ �rr. h , ASs .Sec. . 0/6/2 <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-O I <br />