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MOM—rPage 5 <br /> f 5 <br /> Division records indicate the following permittee contact information. If this information is not current,please type or p�nt <br /> current contact information: <br /> Permittee Contact: Robert Beltramo <br /> Permittee Company: Tony J. Beltramo and Sons. Inc. <br /> Address: ;541 Stockyard Road <br /> Pueblo,CO 81001 <br /> Phone Number: (719)544 <br /> Fax Number: 7 i 9— 5-4`; ,024-7 <br /> Email Address: Tjbsonsincna,q�vestoffice.net t <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 1 <br /> Date <br /> M---4F•C l <br />