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SIGNED, SEALED AND DATED this 30"day of LQc-600" b-e e, <br /> Operator le <br /> (SEAL) <br /> By: �" <br /> Title: ROO z c ovl/ �� G v `x<Q!2 �i, 15a t <br /> NOTARIZATION OF OPERATOR'S ACKNOWLEDGEMENT <br /> STATE OF ( 06 r&.J o ) <br /> �L ` n ) ss.: <br /> COUNTY OF T�lIr1 ) <br /> The foregoing instrument was acknowledged before me this 30"day of j4Lt ,61-- ZO I , <br /> by TD 14114,.. P—hw rs as Qc.*A t Fide. of 9',P.� . <br /> Notary Public <br /> My Commission Expires D 3 --09 —1D S3 <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 /> - 3 - <br />