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Page 5 of 5 <br /> Division records indicate the following permitteeilandowner 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: Jesept .Weitz <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: wee,,610 @ nevort 14641 ck Aro Al <br /> Permitting Contact: Jeseph-e: Ite <br /> ,+ 14 `zp �. <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: 114(' we-Gt411-6) Sv m m11716/,/GAG.. ,C4 41 <br /> Inspection Contact: Jeseph-C� <br /> 41 6-Y7 f e-kv GVeL 717 <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: r <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 /> Coo l r /6/?0,7 <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />