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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: Daniel Tezak <br /> Permittee Company: Byzantine Quarry LLC <br /> Address: 1087 East Holiday Drive <br /> Pueblo West,CO 81007 <br /> Phone Number: (714)547-0363 <br /> Fax Number: ! g\ 5`4, _ 0 3:5 g <br /> Email Address: Dtezak(atezakheavycquipment.com <br /> 1,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 of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> NAF,I <br />