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i <br /> this day of t/!/f'1 SIGNED, SEALED AND DATED <br /> D/��i5�e ✓K/Gr� he �6 �61� � �� a.��� <br /> Operator ' (SEAL) <br /> By: <br /> Title: ,� c , <br /> 3 <br /> i <br /> �� NOTARIZATION OF OPERATOR'S ACKNOWLEDGEMENT <br /> STATE OF (�% 1Gi'ek o ) <br /> ss.: <br /> COUNTY OF (� % � ) <br /> ie`foregoing instrument was acknowledged before_me this �� day off c1 <br /> by as �i'F f t: z�A-c of <br /> ?a' Notary Publi y �� l�C 41 i� 7L'7 <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� 6--`� Date Executed: <br /> Division Director --.-- <br /> Rev.05i 12 <br /> I <br /> - 13 - <br />