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JAN 2 0 2011 <br />Agreement to Conduct Permitting by Electronic Means SIGN OF RECLAMATION <br />MINING & SAFETY <br />Name of permittee representative desiring to <br />opt in to ePermit: ea E —1 <br />4UC4//'L) <br />Title: e, 6:5 -/,C.0 T <br />Name ofpermittee: f p, /,P -s ircj �puCA IL <br />Signature: <br />ePermitting Administrator (ifdiflerent from <br />representative signing agreement) <br />Email Address for ePermit Account: <br />,6 :1- Q add . (VW� <br />Notarized Affidavit of Signature <br />STATE OF: ) <br />.6o <br />COUNTY OF: C/ �) <br />The foregoing instrument was acknowledged <br />before me this <br />(Name of permittee representative) <br />BRIAN WINKLER <br />Notary Public <br />State of Colorado _ <br />Notary la 20134040690 <br />My Commission Expires Jul 1, 2017 <br />(seal) <br />My Commission expires: <br />4.3 <br />day of CT'AI1 , 00/7- by <br />(date) (month) (year) <br />as <br />(title) �— <br />of fj <br />(permittee) <br />NOTARY PUBLIC <br />Page 3 of 6 <br />