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Page 5 <br />Division records indicate the following permittee contact information. If this information is not current, please typ or prc nt <br />current contact information: <br />Permittee Contact: Robert Beltramo <br />Permittee Company: <br />Tony J. Beltramo and Sons, Inc. <br />Address: <br />1541 Stockyard Road <br />Pueblo, CO 81001 <br />Phone Number: <br />7 L4 14 <br />i- y 1 4'-14'--1 <br />Fax Number: <br />M9-64+-024-7 <br />7 � 9_ 64+ —024-' <br />Email Address: <br />Tjbsonsinc(gwestoffice.net <br />z <br />1, the undersigned, hereby state that the information provided in this report is true and accurate, <br />being conducted in accordance with the Division approved mining and reclamation plans. <br />that site operations are <br />Signature of Permittee r ora fficer, Owner, or Documented Designee S +� <br />Date <br />M -AF -01 <br />