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Page 5 of 5 <br /> Division records indicate the following permittee,nandowner 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: Daniel Tezak <br /> Permittee Company: Byzantine Quarry LLC <br /> Address: 1087 East Holiday Drive <br /> Pueblo West,CO 81007 <br /> Phone Number: (719)547-0363 <br /> Fax Number: <br /> Email Address: Dtezak@tezakheavyequipment com <br /> Permitting Contact: Daniel Tezak <br /> Company: Byzantine Quarry LLC <br /> Address: 1087 East Holiday Drive <br /> Pueblo West,CO 81007 <br /> Phone Number. (719)547-0363 <br /> Fax Number: <br /> Email Address: Dtezak@tezakheavyequipment.com <br /> Inspection Contact: Daniel Tezak <br /> Company: Byzantine Quarry LLC <br /> Address: 1087 East Holiday Drive <br /> Pueblo West,CO 81007 <br /> Phone Number: -(70 547-0363 <br /> Fax Number: <br /> Email Address: Dtezak@tezakheavyequipment.com <br /> 1,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 /> p a,� e"� 11/9/2017 <br /> Signature of Permittee.Corporate OMcer,Owner,or Documented Designee Date <br /> awnra� <br />