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SIGNED, SEALED AND DATED this 3 r� day of /'/4 J <br /> d- <br /> Operator (SEAL) <br /> By: <br /> Title: QW12 �er4-� <br /> f� NOTARIZATION OF OPERATOR'S ACKNOWLEDGEMENT <br /> STATE OF �(l/Q yQ O�a ) NICOLE DAWN FRANCIS <br /> ss.: NOTARY PUBLIC <br /> COUNTY OF STATE OF COLORADO <br /> NOTARY ID 20204003105 <br /> MY COMMISSION EXPIRES JANUARY 23,2024 <br /> T e foregoing' trument was acknowledged before me this day of <br /> by as of r/Y <br /> Notary Public <br /> My Commission Expir <br /> STATE OF COLORADO <br /> DEPARTMENT OF NATURAL RESOURCES <br /> MINED LAND RECLAMATION BOARD <br /> DWISION OF RECLAMATION,MINING AND SAFETY <br /> By: Date Executed: <br /> Division Director <br /> Rev.05/12 <br /> - 13 - <br />