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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: Josephine Bassi <br /> R1c��ar-� Hnn <br /> Permittee Company: Josephine Bassi <br /> G <br /> Address: 2046 Lake Ave <br /> Pueblo, , CO 81004 ,-OL4 <br /> Phone Number: (719)852-3225 <br /> Fax Number: C'3 <br /> 71 � y _ 2 3 <br /> Email Address: Dnr_drmsminadmin@state.co.us Ir <br /> Permitting Contact: F2046 <br /> Bassi <br /> I c� r- 1, — CIn <br /> Company: Bassi <br /> Ca s5 i o 4 FQ r L_L_ C, <br /> Address: e Ave �//�� <br /> Pueblo,CO 81004 4,� �-k� T r Ve-rn a - <br /> Phone Number: (719)852-3225C-7fe?) SlIU— p <br /> Fax Number: <br /> -7 / Lf-2-3F <br /> Email Address: Dnr_drmsminadmin@state.co.us <br /> Inspection Contact: Josephine Bassi <br /> Company: Josephine Bassi <br /> LLC <br /> Address: 2046 Lake Ave Pueblo„ CO 81004 A ve-,✓1 G/e- <br /> Phone Number: (719)852-3225 �r / l yo <br /> Fax Number: ! e? 5 <br /> Email Address: Dnr_drmsminadmin@state.co.us ' -or <br /> kpr n e <br /> 1,the undersigned, hereby state that the information provided in this report is true and accurate, and that site op ions are <br /> being conducted in accordance with the Division approved mining and reclamation plans. <br /> 6R. )'aa�g� - 0 La�� q- 1 - 17 <br /> Signature of Permittee,Corporate Officer,Owner, r Documented Designee Date <br /> M-AF-01 <br />