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SIGNED, SEALED AND DATED this day of <br />'Operator (SEAL) <br />By: <br />Title:�i <br />�pS <br />cc o <br />Q <br />ca z V O a <br />NOTARISATION OF OPERATOR'S ACKNOWLEDGEMENT QJ�v VOJQ�o�� <br />STATE OF C a t e�'(-a-d O ) ST AVE O F c <br />ss.: Oo `Ja <br />COUN'T`Y OF C, q vx t Tn S <br />g Z T � ,may <br />The foregoing instrument was acknowledged before me this day of <br />by �.� ci o� C ( I- lee (3�'� S as G -e � ty C, ` 1 o,y7'ti -�� of R1( N s Ca �A 0r w J 1'0 V) <br />Notary Public b <br />My Commission Expires <br />STATE OF COLORADO <br />DEPARTMENT OF NATURAL RESOURCES <br />MINED LAND RECLAMATION BOARD <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />By: Date Executed: <br />Division Director <br />Rev. 05/12 <br />-13- <br />