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SIGNED, SEALED AND DATED this day of A 4�211 .X)D J . <br /> �- <br /> Oper"a'tor f,I- (SEAL) <br /> By: 96W-u 0 <br /> Title: e4AE <br /> NOTARIZATION OF OPERATOR'S ACKNOWLEDGEMENT <br /> STATE OF `�+'(}Q �� ) MELISSA E HERNANDEZ <br /> ssr. NOTARY PUBLIC <br /> COUNTY OF �m,C, ) STATE OF COLORADO <br /> NOTARY ID 19954007940 <br /> MY COMMISSION EXPIRES APRIL 7,2022 <br /> T e foregoing instrument was acknowledged before me this day of 0, � 202-II <br /> by CAC61L as .,,+ Maan a,P of Q. <br /> Notary Public <br /> My Commission Expires Avg-, I 2�22 <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 />