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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: Alta-Flagsn <br /> Permittee Company: Holcim(US)Inc. <br /> Address: 3500 Highway 120 <br /> Florence,CO 81226 <br /> Phone Number: (719)288-1420 <br /> Fax Number: (719)784-2205 <br /> Email Address: n@lafargeholcim.com //11 /N� ���j/N �a j <br /> ;��n@lafargeholcim.com <br /> - g ! UO / G% clile <br /> Permitting Contact: 4oc-taR1' maw. /�JNa s^ <br /> /tl�c <br /> Company: Holcim(US)Inc. <br /> Address: 3500 Highway 120 <br /> Florence, CO 81226 <br /> Phone Number: (719)784-1209 ! 1 1 <br /> Fax umber: A^ � I <br /> Email Address: <br /> Inspection Contact: lee-Em tann <br /> Company: Holcim(US)Inc. <br /> Address: 3500 Highway 120 <br /> Florence,CO 81226 <br /> Phone Number: <br /> Fax Number: <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 /> "0. _ '-Ut J. - 134--J7 <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />