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Page 5 of 5 <br />Division records indicate the following permittee contact information. If this information is not current, please type or <br />print current contact information: <br />Permittee Contact: <br />1, <br />RobertBeltramo <br />Permittee Company: <br />Tony J. Beltramo and Sons, Inc. <br />Address: <br />1541 Stockyard Road <br />Pueblo, C081001 <br />Phone Number: <br />(719) 544-4744 <br />Fax Number: <br />�I q ,,r� � ����•7 <br />Email Address: <br />•r,)F J3 5014yiNGe QLV <br />ET <br />7i0Ff ZA. . N9:7- <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 <br />M -AF -01 <br />A <br />rate Officer, Owner, or Documented Designee <br />Date <br />