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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 print <br /> current contact information: <br /> Permittee Contact: Thomas Musch <br /> Permittee Company: Thomas Musch and Valerie <br /> Musch <br /> Address: 514 Americas Way#3773 <br /> Box Elder, SD 57719 <br /> Phone Number: (720)483-7207 <br /> Fax Number: <br /> Email Address: Vmusch@rocketmaii.com <br /> I,the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are <br /> being cond ted in accordance with the Division approved mining and reclamation plans. <br /> 4 /f� SEPT 21 st Zdlly <br /> Signature of Nknittee, Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-02 <br />