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Page 5 of 5 <br /> <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 /> <br />Permittee Contact: <br /> <br />Frank Leone, Jr <br />Permittee Company: <br /> <br />Leone Sand & Gravel LLC <br />Address: <br /> <br /> <br /> <br />2400 E Main Street <br />Trinidad, CO 81082 <br /> <br />Phone Number: <br /> <br />(719) 846-4170 <br />Fax Number: (719) 845-0605 <br />Email Address: <br />Permitting Contact: <br /> <br />Steve O’Brian <br />Company: <br /> <br />Environment, Inc. <br />Address: <br /> <br /> <br /> <br />7985 Vance Dr. <br />#205A <br />Arvada, CO 80003 <br /> <br />Phone Number: <br /> <br />(303) 423-7297 <br />Fax Number: (303) 423-7599 <br />Email Address: Environment-inc@outdrs.net <br />Inspection Contact: <br /> <br />Frank Leone, Jr. <br />Company: <br /> <br />Leone Sand and Gravel, LLC <br />Address: <br /> <br /> <br /> <br />2400 E. Main St. <br />Trinidad, CO 81082 <br /> <br />Phone Number: <br /> <br />(719) 846-4170 <br />Fax Number: (719) 846-0606 <br />Email Address: <br /> <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 /> <br /> <br />Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date <br />M-AF-01