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SIGNED, SEALED AND DATED this 4'1` day of /q-fIZI L_ <br /> Nt 05G� �G PGfl RA c'idn� �- it�l�Nlrl(� � <br /> Operator (SEAL) <br /> By: <br /> Title: M�t6 e2 <br /> NOTARIZATION OF OPERATOR'S ACKNOWLEDGEMENT <br /> STATE OF C#jQ,GY`ao& ) <br /> COUNTY OF 13 e4t ye K ) SS.: <br /> The foregoing instrument was acknowledged before me this I a- day of <br /> by 0AVI D 005(,4 as µ*,VA 4 QL of M 05CN e-t-,PW AA ii1.d.L Oulj44 GLz <br /> Notary Public tM4W4__q <br /> My Commission Expires ?l?-CI�2 0 <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 />