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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 /> 30600 <br /> Company: General Shale Brick, Inc.-dba-- <br /> Address: 1845 W. Dartmouth Ave. <br /> Denver,CO 80110-1308 <br /> Phone Number: (303)783-3046 <br /> L3°3) �7S 3— 3 os8 <br /> Fax Number: (303)781-1818 ( 03) '7 3- qq <br /> Email Address: <br /> 30,3Or>= icy.� J q(,.)ne,i'n I ( m <br /> Inspection Contact: Tony Fabrizio <br /> (XY)..1) ('VY- (-7'NO <br /> Company: General Shale Brick, Inc,-41ba— <br /> ----obinsen-Brick <br /> Address: 1845 W. Dartmouth Ave. <br /> Denver, CO 80110 <br /> Phone Number: (303)783-3046 ( , o3 �2, - 3 C)5 <br /> Fax Number: (303)781-1818 ) 1—TJ J,?�'-al I G <br /> Email Address: <br /> Le-3 t . n L9c.A.Y,c�o I:)��a/C,6(. cc) <br /> I,the undersigned, hereby state that the information provided in this report is true and accurate, and tl'i t site operations are <br /> being conducted in accordance with the Division approved mining and reclamation plans. <br /> Signa re of Pe ee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />