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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 print <br />current contact information: <br />Permittee Contact: <br />Trent Stafford <br />Permittee Company: <br />Seifert Construction dba Seifert <br />Enterprises, LLC <br />Address: <br />198 Range View Loop <br />Westcliffe, CO 81252 <br />Phone Number: <br />(719) 783-2757 <br />Fax Number: <br />(719) 783-2988 <br />Email Address: <br />aP . a i t •'n a s IjLO(1 <br />0,1l i - Co 01 <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 accordancewit t s - ! ivision approved mining and reclamation plans. <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee <br />M -AF -01 <br />/iZ/5 <br />Date <br />