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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: Trenton Stafford <br /> Permittee Company: Seifert Construction dba Seifert <br /> Enterprises,LLC <br /> Address: 198 Range View Loop <br /> We .Aiffe,CO 81252 <br /> Phone Number: (719)783-2757 <br /> Fax Number: (719)783-2988 <br /> Email Address: Ap.admin@sbcompanies.com <br /> I,the undersigned,hereby sta that the information provided in this report is true and accurate,and that site operations are <br /> being conducted in acc a wit a Division approved mining and reclamation plans. <br /> s-IN('r <br /> Signature of Permittee,Coruorate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />