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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: Joseph C. Welte <br /> Permittee Company: Summit Brick&Tile Co. <br /> Address: P.O. Box 533 <br /> Pueblo, CO 81002-0533 <br /> Phone Number: (719)542-8278 <br /> Fax Number: (719)542-5243 <br /> Email Address: Jwelte@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 conducted in accordance with the Division approved mining and reclamation plans. <br /> ihttataa, v, zc 6 <br /> Signature of Permittee, Corporate Officer, Owner,or Documented Designee Date <br /> M-AF-OI <br />