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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: Trenton Stafford <br /> Permittee Company: Seifert Construction dba Seifert <br /> Enterprises,LLC <br /> Address: 198 Range View Loop <br /> Westcliffe, CO 81252 <br /> Phone Number: (719)783-2757 <br /> Fax Number: (719)783-2988 <br /> Email Address: Ap.admin@sbcompanies.com <br /> Permitting Contact: Mary Seifert <br /> Ire- , �f- or <br /> Company: Seifert Construction <br /> 4-er7 46�i1 r LLL <br /> Address: P.O. Box 305 �DG <br /> Westcliffe, CO 81252 I g� tO""y �e elk) <br /> Phone Number: (719)783-2757 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: Mary Seifert <br /> Company: Seifert Construction aL-�1 G <br /> 4 2-,r� <br /> Address: P.O. Box 305 D <br /> Westcliffe, CO 81252 !� a <br /> Lt/eS�e�� C 60 <br /> Phone Number: (719)783-2757 <br /> Fax Number: -/9 A 3 eZgB� <br /> Email Address: r _ // <br /> I,the undersigned,hereby state t the information provided in this report is true and accurate, and that site operations are <br /> being conducted in accord vc ith the Division approved mining and reclamation plans. <br /> Signature 10T Permittee,Corporate Officer,Owner,or Documented Desienee Date <br /> M-AF-01 <br /> iil CFI i 1 -v`/�1 <br />