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9 (FORM I -All information for DR,IIS use and confidetuial filing) <br /> VIII. SIGNATURE REQUIREMENT <br /> Please <br /> lace you initials on the line provided: <br /> I hereby verify that the foregoins information is true and accurate and commit to the reclamation of the <br /> aforementioned prospecting site as required by the Colorado Mined Reclamation Act and the rules as specified in the <br /> Hard Ro&'Metal Mining Rules and Regulations and this NOI form. <br /> I have enclosed the required permit fee. <br /> I authorize the Division to contact and copy the BLM andror USFS on any correspondence related to the prospecting <br /> operation, if the prospecting operation is located 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 /> I understand that I am not authorized to create anv surface disturbance until the suretv amount is posted and approved <br /> in writing from the Division of Reclamation.\lining 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.34-33-101. <br /> I herby certif` that concurrent with submittal of this NOI to the Division, I have sent notice to the Boards of Count-,- <br /> Commissioners in the Counties where the proposed activities will occur. This notice also indicated that non- <br /> confidential information regarding the proposed activities will be available for revie\% at the Division's website. <br /> This form has been approved br the.1lined Lund Reclanration Board pursuant to section 34-32-113,C.R.S.,of the.11ined Land <br /> Reclamation Act Atrp alteration or modification of this form shall result in voiding arks'A'01 issued on the altered or modified <br /> form and subject the operator to cease and desist orders and civil penalties for operating without a AVI pursuant to section 34- <br /> 32-123.C.R.S. <br /> l the undersigned beine the\01 holder or the person authorized to sign on behalf of the\01 holder.declare that the information <br /> eiven in this NOI form is true and correct. <br /> SIGNATURES MUST BE IN BLUE INK <br /> Signed and dated this day of <br /> Signature of\OI Ider or person auth ' d to sign: <br /> Name(typed or print) Roger L. Day <br /> Title.Position: AMSO Vice President <br />