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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: Randy DiLuzio <br /> Permittee Company: Tezak Heavy Equipment Co.Inc. <br /> Address: 205 Tunnel Dr. <br /> Canon City,CO 81212 <br /> Phone Number: (719)269-1173 <br /> Fax Number: (719)269-1 1 48 <br /> Email Address: Rdiluzior@tezakheavyequipment.com <br /> Permitting Contact: Danny Tezak <br /> Company: Tezak Heavy Equipment Co. Inc. <br /> Address: 205 Tunnel Dr. <br /> Canon City,CO 81212 <br /> Phone Number: (719)269-1173 <br /> Fax Number: <br /> 719-269-1148 <br /> Email Address: <br /> dtezak n tezakheavyequipment.com <br /> Inspection Contact: Danny Tezak <br /> Company: Tezak Heavy Equipment Co. Inc. <br /> Address: 205 Tunnel Dr. <br /> Canon City,CO 81212 <br /> Phone Number: (719)269-1173 <br /> Fax Number: <br /> 719-269-1148 <br /> Email Address: <br /> dtezak u�tezakheavyequipment.com <br /> 1,the undersigned,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> being cond7um in accordance w.th the ' ision approved mining and reclamation plans. <br /> �o a0 7 <br /> Sign atur of Per ttee Cor ,ora Officer,Owner,or Documented Designee date <br /> f�1AFa� <br />