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9 (FORM 2 -Public filing) <br /> VIII. SIGNATURE REQUIREMENT <br /> Pleas pace you initials on the line provided: <br /> I hereby yerifj that the foregoing information is true and accurate and commit to the reclamation of the <br /> aforementioned prospecting site as required by the Colorado dined Reclamation Act and the rules as specified in the <br /> 1) Hard RockAletal Mining Rules and Regulations and this\Ol form. <br /> I have enclosed the required permit fee. <br /> I authorize the Division to contact and copy the BLM and'or USFS on any correspondence related to the prospecting <br /> operation.if the prospecting operation is locdted on federal public Land. <br /> I have also enclosed the appropriate reclamation surety amount or will post an amount as determined by the office. <br /> based on the projected costs of reclamation. <br /> 1 understand that I am not authorized to create any surface disturbance until the surety amount is posted and approved <br /> in writins from the Division of Reclamation,Mining and Safety. <br /> I accept and agree to comply with the foregoing terms and conditions and with all of the provisions of Rules 3 and 5. <br /> and C.R.S.34-32-101. <br /> I herby certiA�that concurrent with submittal of this\01 to the Division, I have sent notice to the Boards of County <br /> Commissioners in the Counties where the proposed activities will occur. This notice also indicated that non- <br /> confidential information reearding the proposed activities%Hill be available for review at the Division's website. <br /> This form has been approved ht'the.1lined Land Reclamation Board pursuant to section 34-32-113,C.R.S.,of due.Mined Land <br /> Reclamation.act. Anr'alteration or modification of this farm shall result in v p'A�voiding alp' issued on the altered or mollified <br /> form and subject the operator to cease and desist orders and civil penalties for operating without a.V01 pursuant to section 34- <br /> 32-123,C.R.S. <br /> 1 the undersigned being the\01 holder or the person authorized to sign on behalf of the\OI holder.declare that the information <br /> liven in this\01 form is true and correct. <br /> SIGNATURES MUST BE IN BLUE INK <br /> Siened and dated this_ day of Z!: <br /> Signature of\OI holder or erson authorized to 'en: <br /> n <br /> Name(n ped or print) <br /> Roger L. Day <br /> Title:'Position: AMSO Vice President <br />