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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 />William G. Johannsen <br />Permittee Company: <br /> <br />Belvedere Stone, LLC <br />Address: <br /> <br /> <br /> <br />C/o Ms. Ginny Kenley <br />2635 Steel Dr <br />Colorado Springs, CO 80907 <br /> <br />Phone Number: <br /> <br />(719) 577-9900 <br />Fax Number: (719) 471-9396 <br />Email Address: Bill.johannsen@ccsand.com <br />Permitting Contact: <br /> <br />William G. Johannsen <br />Company: <br /> <br />Belvedere Stone, LLC <br />Address: <br /> <br /> <br /> <br />2635 Steel Dr <br />Colorado Springs, CO 80907 <br /> <br />Phone Number: <br /> <br />(719) 577-9900 <br />Fax Number: <br />Email Address: <br />Inspection Contact: <br /> <br />William G. Johannsen <br />Company: <br /> <br />Belvedere Stone, LLC <br />Address: <br /> <br /> <br /> <br />2635 Steel Dr <br />Colorado Springs, CO 80907 <br /> <br />Phone Number: <br /> <br />(719) 577-9900 <br />Fax Number: <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