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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: iee,api f` l alle <br /> Permittee Company: The Summit Pressed Brick and <br /> Tile Company <br /> Address: P.O. Box 533 <br /> Pueblo,CO 81002-0533 <br /> Phone Number: (719)542-8278 <br /> Fax Number: (719) 542-5243 <br /> Email Address: e <br /> jute Wet'''. SyM4M7r tde:ck- Ca Al <br /> Permitting Contact: Josepl --Weltefilet mrre feyv 10,...„4 7. <br /> ,77— <br /> Company: Summit Pressed Brick&Tile <br /> Co. <br /> Address: P.O. Box 533 <br /> Pueblo,CO 81002-0533 <br /> Phone Number: (719)542-8278 <br /> Fax Number: <br /> Email Address: (%4/' Gue.6'44tg So 41n1f G^/C-f 'fid <br /> Inspection Contact: desep'rr ette- <br /> 0"T7 I!Cw wCI-r <br /> Company: Summit Pressed Brick&Tile <br /> Co. <br /> Address: P.O. Box 533 <br /> Pueblo, CO 81002-0533 <br /> Phone Number: (719)542-8278 <br /> Fax Number: <br /> Email Address: .j. r <br /> nit Pv4R-C a e Efr9 Nd 7 64‹,4', �w1 <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 /> fftiAC (-1/27-e4 COO I,//6 7?e,`7 <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />