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SIGNED, SEALED AND DATED this day of <br /> Operator (SEAL) <br /> Title: ��. r, <br /> a�.�p,fkY PB�i� <br /> NOTARIZATION OF OPERATOR'S ACKNOWLEDGEMENT Brenda <br /> STATE OF �DY-I&O <br /> ss.: N, s:_,r►cer �O <br /> D '� , _ <br /> COUNTY OF ) dF.uf A <br /> saxi expires <br /> foregoing instrument was acknowledgedbefore me this�day of�i <br /> bye, Vf 1 ,% AAA(- as /IL&W-1 Q of <br /> Notary Public <br /> My Commission Expires _ <br /> STATE OF COLORADO <br /> DEPARTMENT OF NATURAL RESOURCES <br /> MINED LAND RECLAMATION BOARD <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> By: Date Executed: <br /> Division Director <br /> Rev.05/12 <br /> - 13 - <br />