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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: Kent Beach <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)782-2988 <br /> Email Address: Ap.admin@sbcompanies.com <br /> Permitting Contact: Joe Gagliano <br /> Company: L.J. Development, Inc. <br /> Address: 159 Tiffany Ct. J <br /> Pueblo,CO 81005 g� V t w Loop <br /> -4-'te Co e/;s <br /> Phone Number: (719)240-9424 <br /> —71 773-- Z.75� � <br /> Fax Number: (719)564-3088 7 — 9- -;2—95"'T <br /> Email Address: 61C0 • C &/ <br /> Inspection Contact: Jerald A. Seifert <br /> Company: Seifert Construction <br /> Address: P.O. Box 210 JC y- <br /> Westcliffe, CO 81252 <br /> 2— <br /> Phone Number: (719)783-2757 <br /> Fax Number: (719)782-2988 <br /> Email Address: �tdiYl.i/1 (�s�j�pry1 if'S•C <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 accord ce with the Division approved mining and reclamation plans. <br /> Signature of ermittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />