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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: Tony Fabrizio <br /> Permittee Company: General Shale Brick, Inc. <br /> Address: 1845 W. Dartmouth Ave. <br /> Denver,CO 80110-1308 <br /> Phone Number: (303)783-3041 <br /> Fax Number: (303)783-2992 <br /> Email Address: Tony.fabrizio@generalshale.com <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 a cordance with the Division approved mining and reclamation plans. <br /> Signathre of PerjAittee4 Corporate Officer Owner,or Documented Designee Date <br /> M-AF-01 <br />