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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: Thomas J.Murray <br /> Permittee Company: The Lakewood Brick and Tile <br /> Company <br /> Address: 1325 Jay St <br /> Lakewood,CO 80214-2052 <br /> Phone Number: (303)238-5313 <br /> Fax Number: (303)237-7737 <br /> Email Address: Tmurray@summitbrick.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 cond ted in a rdanc ith the Division approved mining and reclamation plans. <br /> Si ature of mittee, orporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br /> Note: Additional information is provided on <br /> attached page. <br />