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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: Joseph C. Welte <br /> Permittee Company: Summit Brick&Tile Co. <br /> Address: P.O. Box 533 <br /> Pueblo,CO 81002-0533 <br /> Phone Number: (719)542-8278 <br /> Fax Number: (719) 542-5243 <br /> Email Address: <br /> Permitting Contact: Joseph C. Welte _ <br /> Company: Summit Brick&Tile Co. <br /> 6NV1 rZ Cam" INC <br /> Address: P.O. Box 533 79 8 T v fi Nam,,., to AX , W,7e- 705 A <br /> Pueblo,CO 81002-0533 <br /> /i�v►4DA , Co 06003 <br /> Phone Number: (719) 542-8278 <br /> Fax Number: a y Lam-& w-7 S-91 <br /> Email Address: C6V 1 P`DAN GAG -%NC. 9 0W*d50 . NP-t- <br /> Inspection Contact: Joseph C.Welte <br /> Company: Summit Brick&Tile Co. <br /> Address: P.O. Box 533 <br /> Pueblo,CO 81002-0533 <br /> Phone Number: (719)542-8278 <br /> Fax Number: <br /> Email Address: <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 /> 61d�(V � /3 poi <br /> Signature of Permittee,Corvorate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />