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Page 5 of 5 <br /> Division records indicate the following permittee/landowner 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: Clint Beck <br /> Permittee Company: <br /> 'ETAL 1 Eolo G iJ S n/c <br /> Address: P.O. Box 440 <br /> Rapid City, SD 57709 <br /> Phone Number: (605)342-7224 <br /> Fax Number: <br /> Email Address: <br /> e I�ecJL�tee.-l-c1�2✓t.Go n-t �� <br /> Permitting Contact: <br /> C L i N T —)6EGIL C/ <br /> Company: �rado.lien Company <br /> Address: P.O. Box 440 <br /> Rapid City, SD 57702 <br /> Phone Number: - <br /> C6os) <br /> Fax Number: <br /> Email Address: rr <br /> C 4ec1� O .g�� erl • to <br /> Inspection Contact: <br /> �cr-fA�� Ca�c.c.iHr7Z- Ci <br /> Company: <br /> 1't.1"E BEN ` soNS �itltr. <br /> Address: P4LBa.Y4"4= <br /> F.,�...,. n.-. .,c �nLI <br /> (,?itPr p Ct ry, 50 <br /> Phone Number: - (&o 5) <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 /> C`t 71�1� <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br />