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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: ora o 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 /> Permitting Contact: Sl @115,99eksen- <br /> Company: �E TT-- ► N o Sow s� �"/L. <br /> Address: P.O. Box 440 <br /> Rapid City, SD 57702 <br /> Phone Number: (695)3 -8 <br /> Fax Number: <br /> Email Address: <br /> Inspection Contact: i Mosey <br /> � L t.G/t <br /> Company: -J;L 12� s <br /> Address: 120 Box 196J 1 0 11-3OX 'q41 d <br /> Phone Number: {9;0)493-6294 (& O S) :>'l 2 — 7 2 2 <br /> Fax Number: <br /> Email Address: C Fj c a It <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 /> kaalu� ,1-2��L C <br /> Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date <br /> M-AF-01 <br /> �4 ' /^/// V <br /> i <br />