Laserfiche WebLink
9 <br />VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the line provided: <br />1 1'*& 1 hereby verify that the foregoing information is true and accurate and commit to the reclamation of the <br />aforementioned prospecting site as required by the Colorado Mined Reclamation Act and the rules as specified in the <br />Hard Rocklbletal Mining Rules and Regulations and this NOI form. <br />I have enclosed the required permit fee. <br />€ authorize the Division to contact and copy the BLM and/or USFS on any correspondence related to the prospecting <br />operation; if the prospecting operation is located on federat public land. <br />. I have also enclosed the appropriate reclamation surety amount or will post an amount as determined by the office, <br />Tbis form bas been approved by Me Mitred Land Reclamation Board pursuant to section 34-32-113,0 P.S, of the Mined Land <br />Reclamation Act. Any alteration or modification of tltit farm sliall result in voiding any IV07 issued on the altered or modified <br />fore: and subject the operator to cease and desist orders and civil penalties for operating without a NO1 pursuant to section 34- <br />32-123, C.R.S. <br />based on the projected costs of reclamation. <br />I understand that I am not authorized to create any surface disturbance until the surety amount is posted and approved <br />in writing from the Division of Reclamation, Mining and Safety. <br />1 accept and agree to comply with the foregoing terms and conditions and with all of the provisions of Rules 3 and 5, <br />and C.R.S. 34-32-101. <br />1, the undersigned. being the NOI holder or the person authorized to sign on behalf of the NOI holder, declare that the information <br />given in this NO€ form is true and correct. <br />SIGNATURES MUST BE IN BLUE INK <br />S? <br />Signed and dated this IQLI day of <br />Signature of NOI holder or person authorized to sign: <br />Name (typed or print) al`Nk W-' SA <br />Title/Position: Env I YCMY' <br />(, !(Itshnre;vsf'errms,Q7-9?7-0I vsfi =5nl % ing fortns'NOI Prosm-ling Ann. 07124103