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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: Jnseph-c-WeRe, <br /> Permittee Company: Summit Brick&Tile Co. <br /> Address: P.O. Box 533 <br /> Pueblo, CO 81,002-0533 <br /> Phone Number: (719)542-8278 <br /> Fax Number: (719)542-5243 <br /> Email Address: <br /> /h r 1.-�e-h? V z v m ®46^,e 4- e-r-v&,, <br /> Permitting Contact: Lloyd V." <br /> J I1/G Q <br /> Company: , <br /> Address: 1"1` V A"C � �� <br /> w 1� . 2 CIS-6 <br /> A Oft (-,o �-'e <br /> Phone Number: ( <br /> Fax Number: . <br /> Email Address: <br /> Q AC' O J`s,elet <br /> Inspection Contact: 3esre- I Gt/C7.Z <br /> Company: Summit Brick&Tile Co. <br /> Address: P.O.Box 533 <br /> Pueblo,CO 81002-0533 <br /> Phone Number: (719) 542-8278 <br /> Fax Number: <br /> Email Address: <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 /> 6Z I�L12 <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />