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Page 5 of 5 <br /> Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have <br /> information on record). If this information is blank or not current,please type or print current contact information: <br /> Permittee Contact: Robert Tibbetts <br /> Permittee Company: The Denver Brick Company <br /> Address: 401 Prairie Hawk Dr. <br /> Castle Rock, CO 80109 <br /> Phone Number: (303) 688-6951 <br /> Fax Number: (303) 688-5270 <br /> Email Address: Rtibbetts@brick.com <br /> Permitting Contact: Robert Tibbetts <br /> Company: The Denver Brick Company <br /> Address: 401 Prairie Hawk Dr. <br /> Castle Rock, CO 80109 <br /> Phone Number: (303)688-6951 <br /> Fax Number: <br /> Email Address: Rtibbetts@brick.com <br /> Inspection Contact: Robert Tibbetts <br /> Company: The Denver Brick Company <br /> Address: 401 Prairie Hawk Dr. <br /> Castle Rock, CO 80109 <br /> Phone Number: (303) 688-6951 <br /> Fax Number: C <br /> Email Address: Rtibbetts@brick.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 /> � <br /> Signature of Permittee, Corporate fficer,Owner,or Documented Designee Date <br /> M-AF-01 <br />