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OJ <br />VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the line provided: <br />F✓ <br />6v <br />6d <br />L <br />I hereby verify that the foregoing <br />aforementioned prospecting site as re <br />Hard Rock/Metal Mining Rules and F <br />I have enclosed the required permit fee. <br />ORM 2 - Public filing) <br />mation is true and accurate and commit to the reclamation of the <br />by the Colorado Mined Reclamation Act and the rules as specified in the <br />.ions and this NOI form. <br />I authorize the Division to contact and cop the BLM and/or USFS on any correspondence related to the prospecting <br />operation, if the prospecting operation is to ated on federal public land. <br />I have also enclosed the appropriate <br />based on the projected costs of reclai <br />I understand that I am not authorized to <br />in writing from the Division of Recl= <br />I accept and agree to comply with the <br />and C.R.S. 34 -32 -101. <br />I herby certify that concurrent with subr <br />Commissioners in the Counties where <br />confidential information regarding the pi <br />ion surety amount or will post an amount as determined by the office, <br />e any surface disturbance until the surety amount is posted and approved <br />Mining and Safety. <br />terms and conditions and with all of the provisions of Rules 3 and 5, <br />of this NOI to the Division, I have sent notice to the Boards of County <br />proposed activities will occur. This notice also indicated that non - <br />-d activities will be available for review at the Division's website. <br />This form has been approved by the Mined Land Recla adon Board pursuant to section 34 -32 -113, C.R.S., of the Mined Land <br />Reclamation Act Any alteration or modification of th' form shall result in voiding any NOI issued on the altered or modified <br />form and subject the operator to cease and desist order and civil penalties for operating without a NOI pursuant to section 34- <br />32-123, C.R.S. <br />given in this NOI form is true and correct. <br />Signed and dated this <br />LZ <br />SIGNATURES MUST BE IN BLUE INK <br />day of <br />Signature of NOI holder or person authorized to sign: <br />1 c9jO��, yao� <br />Name (typed or print) Florentino Vueivas <br />Title/Position: Staff Environment <br />