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SIGNED, SEALED AND DATED this day of <br /> Operator (SEAL) <br /> c <br /> By: Q O c A Peo-vf <br /> Title: Ve kL?t—Cj^,L. GtIC iG lyc-. <br /> NOTARIZATION OF OPERATOR'S ACKNOWLEDGEMENT <br /> STATE OF l ls`f 4zk C) ) <br /> ss.: <br /> COUNTY OF J e . <br /> The foregoing'pcl <br /> strument was acknowledged before me this Z� day of � (.Z�l Q Zh <br /> by K4 V L(1 4,( � as U t' of l - f c'L Z <br /> SARAN GREGA n' (1C. <br /> Nota Public G�.t'r�k <br /> -XIL <br /> NOTARY PUBLIC <br /> STATE OF COLORADO My Commission Expires 21 7i t 2 <br /> NOTARY ID 20174007757 <br /> MY COMMISSION EXPI ES FERRUARV 21.;nl'. <br /> S T A .. j <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 />