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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: Harold Stickler <br /> Permittee Company: General Shale Brick, Inc. <br /> Address: 1845 W. Dartmouth Ave. <br /> Denver, CO 80110-1308 <br /> Phone Number: (303)783-3071 <br /> Fax Number: (303)783-2992 <br /> Email Address: Harold.stickler@generalshale.com <br /> Permitting Contact: Tony Fabrizio (� <br /> I n G VOI <br /> Company: General Shale Brick, Inc. <br /> Address: 1845 W. Dartmouth Ave. <br /> Denver, CO 80110-1308 <br /> Phone Number: (303)783-3046 ( 30-3) 3('7 <br /> Fax Number: (303)781-1818 (3 0:3) 1 3 _ y <br /> Email Address: y^1_)0i> <br /> Inspection Contact: Tony Fabrizio <br /> 3 Q ( ) � � �(���4•rI .I <br /> Company: General Shale Brick, Inc. <br /> Address: 1845 W. Dartmouth Ave. <br /> Denver, CO 80110-1308 <br /> Phone Number: (303)783-3046 ?) '/S3- 305S <br /> Fax Number: (303)781-1818 C3 ) ► S q <br /> Email Address: n <br /> Ju�t�'r>, t��L3CC,�'Rd,?_r)c v-611 <br /> I,the undersigned,hereby state that the information provided in this report is true and accurate, and that siteoperationsare <br /> being conducted in accordance with the Division approved mining and reclamation plans. <br /> P/07 <br /> Signature Permitte rporate Officer,Owner,or Documented Designee Date <br /> M-AF-OI <br />