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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: John M. Clement <br /> Permittee Company: Keystone Portfolio Management, <br /> LP <br /> Address: 13020 FM 1641 <br /> Forney, TX 75126 <br /> Phone Number: (972)564-2192 <br /> Fax Number: <br /> C °II2. <br /> Email Address: 6V 61 <br /> Permitting Contact: <br /> JA4 <br /> Company: KG�7 rvnG Porgy alto �►� - <br /> Address: 13DZo �rv1 I J 1+1 <br /> Frf.�eX, q -15 i 2- <br /> Phone Number: (q�� 5�q ' <br /> Fax Number: m 2 Slv 21 <br /> Email Address: 1 <br /> �����i4 55 L�s� • G.o vv, <br /> Inspection Contact: <br /> Company: <br /> Address: <br /> Phone Number: 24 <br /> Fax Number: C9 7 //�6'I J z O <br /> Email Address: 45`(6 <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 /> � � - - - ZI 7 <br /> Fnature ot Permittee,Corporate Officer,Owner,or Documented Desiane 6ate <br /> M-AF-01 <br />