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c1" <br /> Page-9- <br /> Lj <br /> jE UNITED STATES OF AMERICA <br /> BY 'V1�'f Solvay Chemicals Inc ' <br /> (Company or Lessee Name) <br /> Lonny R.Bagley �� <br /> (Signing Officer) (Signature of Lessee) <br /> _Deputy State Director.Division of Energy Lands and Minerals /ir c s. n�• <br /> (Title) (Title)) <br /> Title 18 U.S.C.Section 1001,makes it a crime for any person knowingly and willfully to make to any department or agency of the United States <br /> any false,fictitious or fraudulent statements or representations as to any matter within its jurisdiction i <br /> NOTICES The Paperwork Reduction Act of 1995 requires us to inform you that:Ti, 3 <br /> The Privacy Act of 1974 and the regulation in 43 CFR 2.48(d)provide <br /> that you be furnished with the following information required by this BLM collects this information to comply with the regulations at 43 CF <br /> application. 3500, which implement the provisions of the Mineral Leasing Act t <br /> AUTHORITY:30 U.S.C. 181 et seq.,43 U.S.C.3500 1920,as amended;the Mineral Leasing Act for Acquired Land of 194' <br /> PRINCIPAL, PURPOSE: The BLM will use the information you and section 402 of Reorganization Plan No.3 of 1946.-I'he BLM uses th <br /> provide to verify your compliance with lease terms. information to verily that you are complying with lease terms.Response I <br /> ROUTINE. USES: The BLM will disclose information to: (1) this request is required to obtain and keep a benefit.The BLM would lik <br /> appropriate Federal, State, local or foreign agencies when relevant to you to know that you do not have to respond to this or any other Feden <br /> civil, criminal, or regulatory investigations or prosecutions; (2) agency-sponsored information collection unless it displays a currentl <br /> appropriate Federal agencies when their concurrence is required before valid OMB control number. <br /> BLM grants a right in public lands or resources; (3)a member of the <br /> public in response to a specific request for pertinent information;(4)a BURDEN HOURS STATEIMENT:Public reporting burden for this fon r <br /> congressional office in response to an inquiry made at the request of an is estimated to average 300 hours per response, including the time fi <br /> individual:and(5)toa consumer reportingagencyto expedite collectiug reviewing instructions,gathering,and maintaining data,and complctin <br /> debts owed the government. and reviewing the form.Direct comments regardingthe burden estimate( <br /> EFFECT OF NOT PROVIDING INFORMATION: Filing of the anyotheraspect of this form to U.S.Department of the Interior.Bureau( r <br /> information is required to obtain and keep a benefit. If you do not Land Management(1004-0121),Bureau lnformation Collection Clearam <br /> provide the intonnation,BLYI may seek to cancel your lease. Officer(WO-630), 1849 C Street,N.W.,Mail Stop 40t LS.Washingtor <br /> D.0 20240. <br /> t <br /> a <br /> a <br /> 1 <br /> I <br /> a <br /> a <br /> a <br /> I <br /> 1 <br /> i <br /> S <br /> r <br /> 7 <br /> S <br />