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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: Clint Beck <br /> Permittee Company: Colorado Lien Company " <br /> Address: P.O.Box 440 ° <br /> Rapid City,SD 57709 <br /> Phone Number: (605)342-7224 <br /> Fax Number: <br /> Email Address: <br /> C c ,er(, cs�✓�t <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 /> �X&�Lk <br /> 9 2- <br /> //(I <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />