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Page 5 of 5 <br />Division records indicate the following permittee contact information. If this information is not current, please type or <br />print current contact information: <br />Permittee Contact: DanieWAViebers <br />L IA-) -T— <br />PermitteePermittee Company: Colorado Lien Company <br />Address: P.O. Box 440 <br />Rapid City, SD57709 <br />Phone Number: 605) 342-7224 <br />Fax Number: <br />Email Address: <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 />Signature <br />M -AF -01 <br />Owner, or Documented Designee <br />9 1126152 <br />ate