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9 (FORM 2-Public filing) <br /> VIII. SIGNATURE REQUIREMENT <br /> Please place you initials on the line provided: <br /> Aj;_— I hereby verify that the foregoing information is true and accurate and commit to the reclamation of the <br /> aforementioned prospecting site as required by the Colorado Mined Reclamation Act and the rules as specified in the <br /> Hard Rock/Metal Mining Rules and Regulations and this NOI form. <br /> I have enclosed the required permit fee. <br /> I authorize the Division to contact and copy the BLM and/or USFS on any correspondence related to the prospecting <br /> operation,if the prospecting operation is located on federal public land. <br /> I have also enclosed the appropriate reclamation surety amount or will post an amount as determined by the office, <br /> based on the projected costs of reclamation. <br /> I understand that I am not authorized to create any surface disturbance until the surety amount is posted and approved <br /> in writing from the Division of Reclamation,Mining and Safety. <br /> I accept and agree to comply with the foregoing terms and conditions and with all of the provisions of Rules 3 and 5, <br /> �and <br /> C.R.S.34-32-101. <br /> �4he�rby certify that concurrent with submittal of this NOI 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 /> confidential information regarding the proposed activities will be available for review at the Division's website. <br /> This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32-113, CR.S.,of 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 subject the operator to cease and desist orders and civil penalties for operating without a NOI pursuant to section 34- <br /> 32-123,C.RS. <br /> I the undersigned,being the NOI holder or the person authorized to sign on behalf of the NOI holder,declare that the information <br /> given in this NOI form is true and correct. <br /> SIGNATURES MUST BE IN BLUE INK <br /> Signed and dated this a r b6 day of a C7 1 <br /> Signature of NOI holder or person thorized to sign: <br /> Name(typed or print) / 1/:b-ef" IL �'C C S w <br /> Title/Position: <br />