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SIGNED, SEALED AND DATED this 2-7 day of _. <br />Operator (SEAL) <br />By: <br />Title: <br />hem <br />NOTARIZATION OF OPERATOR'S ACKNOWLEDGEMENT <br />STATE OF <br />ss.: <br />COUNTY OF (,Q (,� yam, �� ) <br />The foregoing instrument was acknowledged before me this? day of 20/`� <br />by as of <br />LORI THOMPSON Notary Public p <br />NOTARY PUBLIC <br />STATE OF COLORADO My Commission Expires 2-0 <br />NOTARY ID 20034039846 <br />MYCOMMISSION EXPIRES NOV. 21, 2015 <br />STATE OF COLORADO <br />DEPARTMENT OF NATURAL RESOURCES <br />MINED LAND RECLAMATION BOARD <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />By: <br />Division Director <br />-13- <br />Date Executed: <br />Rev. 05/12 <br />