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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: Trent Stafford <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)783-2988 <br /> Email Address: Ap.admin@sbcompanies.com <br /> Permitting Contact: Mary Seifert <br /> S <br /> Company: Seifert Construction <br /> Address: 60160 Hwy. 69 N <br /> P.O.Box 210 62' r V, ett) 1--63,op <br /> Westcliffe, CO 81252 weski/ 4'-�t. co el <br /> Phone Number: (719)783-2988 711- <br /> p,3 - ?.7 6 1 <br /> Fax Number: 71 - 78'3 <br /> - (9-9ft iv- <br /> Email Address: � e //�� <br /> alp • eats'',en. 6 S Eco a.n r c5• cow}/ <br /> Inspection Contact: Mary Seifert a� (1 ✓ <br /> Company: Seifert Construction <br /> . - :erf -(1#erpri t-5 LL-6 <br /> Address: 60160 Hwy. 69 N e, v r etae <br /> P.O. Box 210 <br /> Westcliffe, CO 81252 Wes{-cA C D S'e S <br /> Phone Number: (719)783-2988 <br /> 711- 7113— (2751 <br /> Fax Number: .7'1-7r3- -9 / <br /> Email Address: / ✓ <br /> • ecrGI-Len ® S 6Co rnyx,aks _cern// <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 accordance with the Division approved mining and reclamation plans. <br /> X047 <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />