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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: Joe Gagliano <br /> Company: L.J.Development, Inc. <br /> S*e;-rerl- �r` err� srs [ L ✓ <br /> Address: 159 Tiffany Ct. <br /> Pueblo,CO 81005 pie e U i ccv Lcxv <br /> W eSice Cv ( (as- <br /> Phone <br /> rasPhone Number: (719)240-9424 <br /> 1( - 7 — 0215-7 vi <br /> Fax Number: (719)583-0768 1/ <br /> `7(4-74"3 <br /> Email Address: ok ckM en (� 5 6 co m`da.n i e5- cowl <br /> Inspection Contact: Kent Beach <br /> Company: Seifert Construction <br /> v- Per-Ir��cs LLL <br /> Address: 198 Range View Loop /CI p. ,— e- V ieW Loop <br /> p <br /> P.O. Box 210 7 <br /> Westcliffe, CO 81252 w e C l e o 6 0 E/o2 s.1- <br /> Phone Number: (719)783-2757 <br /> 7 '3_ a757 <br /> Fax Number: -71 q - 7:3— <br /> g1 g s, <br /> Email Address: n, 4.6120%i n 6 c o1 an e5• corn V <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 ord e with the Division approved mining and reclamation plans. <br /> 2 ,740 <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />