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DECEIVED <br /> Agreement to Conduct Permitting by Electronic Means <br /> JUN 24 2016 <br /> DIVISION OF RECLAMATION <br /> MINING&SAFETY <br /> Name of permittee representative desiring to <br /> opt in to ePermit: 1--GLtd(>1✓IG-e— �itkL <br /> Name of permittee: <br /> Title: <br /> Signature: <br /> Email Address for ePermit Account: <br /> q 6' <br /> .�a <br /> Notarized Affidavit of Signature <br /> STATE OF: <br /> COUNTY OF: ) ss. <br /> The foregoing instrument was acknowledged <br /> before me this day of by <br /> (date) (Oar) <br /> / as � <br /> A 46 <br /> (Name of permittee representative) (title) <br /> of <br /> ArZAVO P"40 <br /> (permittee) <br /> L rGl4 cps <br /> NOTARY PUBLIC <br /> D'`r1 <br /> (seal) `��O2 <br /> My Commission expires: �yQTA�RY <br /> PUBLI <br /> ••.. .... <br /> (X <br /> �scsxrs- <br /> Page 3 of 4 <br />