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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: Tony Fabrizio <br /> H q vo O St (-k ir. l-j <br /> Permittee Company: General Shale Brick, Inc. <br /> Address: 1845 W. Dartmouth Ave. <br /> Denver, CO 80110-1308 <br /> Phone Number: (303)783-3041 <br /> 2 <br /> Fax Number: (303)783-2992 <br /> Email Address: <br /> Permitting Contact: Tony Fabrizio 1 <br /> Company: General Shale Brick, Inc. dba <br /> Robinson Brick v f=nP c-n,l J k"4 , (/ <br /> Address: 1845 W. Dartmouth Ave. <br /> Denver, CO 80110-1308 <br /> Phone Number: (303)783-3046 C 3 2io 5 <br /> Fax Number: (303)781-1818 r n <br /> Email Address: <br /> Inspection Contact: Tony Fabrizio rr <br /> Company: General Shale Brick, Inc. dba <br /> Robinson Brick C�{'-n("c-,q J } 'l 1c, '' { c'_I <br /> Address: 1845 W. Dartmouth Ave. <br /> Denver,CO 80110-1308 <br /> Phone Number: (303)783-3046 <br /> Fax Number: (303)781-1818 J all <br /> 1 <br /> Email Address: V <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 /> 3 - 3/ -/7 <br /> Signat a of Permi a Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />