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M-1997-064 <br /> M-2002-004 <br /> Agreement to Conduct Permitting by Electronic Means P-2003-019 <br /> P-2003-020 <br /> P-2003-013 <br /> Name of permittee representative desiring to 0//�� <br /> opt in to ePermit: ��W I►'1 ) i vcl r C3 <br /> Title: E,i yIra"Y"en Ic, / I0nCtger- <br /> Name of permittee: <br /> GCC. (-,o GrAhC4,e, l—,y7c-. <br /> Signature: <br /> ePermitting Administrator(if different from <br /> representative signing agreement) <br /> Email Address for ePermit Account: EOLIv,,�DES @ C-CC• Cott <br /> RECEIVED <br /> Notarized Affidavit of Signature <br /> SEP 2 0 2016 <br /> DIVISION OF RECLAMATION <br /> STATE OF: L l p r'a d b ) MINING AND SAFETY <br /> COUNTY OF: ) ss. <br /> The foregoing instrument was acknowledged <br /> before me this ) 2L4—day of Sep+. 2-0 I�. by <br /> (date) (month) (year) <br /> r n �t,, <br /> FAI.J n r� as i �livas F- <br /> V1V-0V1men � Onage,r <br /> (Name of permittee representative) (title) <br /> of <br /> C.�C C- �►U �ra►1 �e , .Zn C <br /> (permittee) <br /> JACKI SERNA <br /> Notary Public <br /> State of Colorado TARY PUBLIC <br /> Notary ID 20144042744 <br /> EMyommission Ex ires Nov 4, 2018 <br /> (seal) <br /> My Commission expires: <br /> Page 3 of 6 <br />