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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: Greg Norwick <br /> (zossel l A Lam-iz- a✓ <br /> Permittee Company: Everist Materials,LLC <br /> Address: P.O. Box 1150 5l T-t..E-E A v e <br /> Silverthorne,CO 80498 <br /> 4F4-0e crib t'o <br /> gl5-d1 <br /> Phone Number: (970)468-2521 q p 241_ S3 - - <br /> Fax Number: <br /> Email Address: Gnorwick@evmat.com <br /> Permitting Contact: Greg Norwick <br /> Lib V\I (ViVe tte/{ <br /> Company: Everist Materials,LLC <br /> Address: P.O. Box 1150 5$10 4VE <br /> Silverthorne,CO 80498 C e-PWD Jturcrevvi 60 <br /> 51,5-of <br /> Phone Number: (970)468-2521 <br /> �J ?-ozo9g <br /> Fax Number: <br /> Email Address: Gnorwick@evmat.com -mG A 5 ?6-,Clik t-,J(- Cin—TA�T <br /> Inspection Contact: Greg Norwick — 11 <br /> \ Jo..) �F` \vel <br /> Company: Everist Materials,LLC <br /> Address: P.O.Box 1150 <br /> Silverthorne,CO 80498 <br /> Phone Number: (970)468-2521 <br /> Fax Number: <br /> Email Address: Gnorwick@evmat.com <br /> , •5'. •114 Lit (Pe 190rect>410n16 <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 D.• .ion a .roved mining and reclamation plans. <br /> T'►1 03/01/zo 16 <br /> Signature of Permittee, 1 1 rp 1 rate 0 'cer,0 er,or Documented Designee Date <br /> M-AF-01 <br />