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9 (FORM z - rr,bliu fl;ttg) RECEIVED <br />VIII. SIGNATURE REQUIREMENT AUG 19 M5 <br />GRARD JUNCTION FIELD OFFICE <br />DivlStON OF <br />P1z:Mz; 5lace you initials on the line provided: REU-WTIC;N MINING & SAFETY <br />I hereby verify that the foregoing information is true and accurate and commit to the reclamation of the <br />ato1eu1euLuuea N10aNCCtujg aitC as iCyuuCCl by tnC C,olmaav Mui'ca KcClauiaGou ACt aua tnC iul'ca as aPCCiii'ca it, tnc <br />H20 Kock/MCtal [vi—;,q; rules and reg„ lations and this NOI form. <br />1 have micloaea the jeyuuCa NCuwt tee. <br />I authorize the Division to contact and copy the BLM and(or USFS on any correspondence related to the prospecting <br />Operation, it the piubpecting opriatiOu is Iocatea ou tedeldl Public laud. <br />I have also enclosed the appropriate reclamation surety amount or will post an amount as determined by the office, <br />ba3Ca ou the PrvjecteE Coats of ler'lanra6011. <br />I understand that I aw not authoriLed to create any aurtaCe aistuibUJIM uuril the ahrety aurouut is postca ana approvea <br />in wiaLub tr0Au tnr uivi.iou of KcClau,atiou, lvluuug and Jafiay. <br />I accept ana agree to comply with the toregoing teuua ana Conaitionb aua with all of the Nroviaioua of Kules J aua J, <br />zmd l_:.r.S.-14-3L-1 U 1. <br />1 herby certify that concurrent with submittal of this N01 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 />CoutraCutial urtouuativn irgartlurg the propuaea activities will be available tot review at the Uiviaiou a wMSitc. <br />I h;j jUtttt has bta:/t app,V7 Uisl by the 017a, IT pttutii7nt tD au tiurt C.K..S., Uf the mined Land <br />Reclamation Act Any alteration or modification of this form shall result in voiding any NOI issued on the altered or modified <br />form and aubjuct the uperutur tv cemu uttd dusiat uraera urd7 C;v;l pertatt[ea Jur uperatutg w;thatit u NVj patauunt to aeCl;Dtt 14- <br />1L -/L1, C.K.J. <br />I, the uuaeraiUuea beiu = the NUI MOM u, th_C Craou auttlouc'ca to ,; a ou penalt of tnc N01 nvine., NeClare mat the uwivuuativu <br />v�rrcn itrthislVl t fe.—;sr-and-eor-Feet. - - <br />SIUNAIUKLS MUST KL IN KLUL INK <br />1� <br />�ig,.rd and dated this day of \.%%�jT 2 U( 5 <br />Signature of NUI holaci or perbou autho,iiuU to sign: <br />Name (typed or print) t V1 Gt 2�d]Q1I V- <br />141C t'0artror.: C. VA V (iU1� t'�Vl y'�/ L( �' y <br />