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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: Thomas J. Murray <br /> Permittee Company: The Lakewood Brick and Tile <br /> Company <br /> Address: 1325 Jay St <br /> Lakewood,CO 80214 <br /> Phone Number: (303)238-5313 <br /> Fax Number: (303)237-7737 <br /> Email Address: Tmurray(cLsumitbrick.com <br /> Permitting Contact: 4M. <br /> Tom Murray <br /> Company: The Lakewood Brick and Tile <br /> Company <br /> Address: 1325 Jay St <br /> Lakewood,CO 80214 <br /> Phone Number: (303)238-5313 <br /> Fax Number: <br /> Email Address: Tmurray@summitbrick,com <br /> Inspection Contact: Torn Murray , / <br /> Company: The Lakewood Brick and Tile v <br /> Company <br /> Address: 1325 Jay St <br /> Lakewood, CO 80214 <br /> Phone Number: (303)238-5313 <br /> Fax Number: <br /> Email Address: Tmurray@summitbrick.com <br /> 1,the undersigned, hereby state that he information provided in this report is true and accurate,and that site operations are <br /> being conducte in accor a e w. the Division approved mining and reclamation plans. <br /> C6CD . qZ15 /7 <br /> Signat re of Per tee Cor rate O cer,Owner,or Documented Desienee Date <br />