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VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the line provided: <br />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 Rock/Metal Mining Rules and Regulations and this NO[ form. <br />i have enclosed the required permit fee. <br />I authorize the Division to contact and copy the BLM and/or USFS on any correspondence related to the prospecting <br />operation; if the pr ng.operation is loomed on federal public land. <br />I have also enclosed the appropriate reclamation surety amount or will post an amount as determined by thoffice., <br />on the projected costs of reclamation. <br />based understand that I am not m. Wwrized.to creme any surface disturbance until the surety amount is. posted and approved <br />in writing from the Division of Reclamation, Mining and Safety. <br />I accept and agree to comply with the foregoing terms and conditions and with all of the provisions of Rules 3 and. , <br />and C.R.S. 34-32-101. <br />This form -*as been moved by the Mined Land Rectmnatvn Board purmiaw to section 34-32--113,0 RS, of &e Mined Lard <br />Rac a Act Any ahwol n or mod#la dan of this form shall result In voiding any NOl hated on the ahered or modifted <br />forth and swbjeet.the operator to cease and des W orders and cbHpmffh1aJbr operating without a N01 pursuant to section 34- <br />32-123, CAL <br />[ the undersigned, being the NOI holder or the p neon s ized to sign on behalf of the NCH holder declare that the inf?on <br />given in. this NOI form is true and correct. <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this a y day of S Q N 1E <br />Signature of NOI holder or person authorized to sign: <br />Name (typed or print) -a FF or„}2=.R S <br />Title/Position: hAANg ER Off EN GIN fiERt b1T <br />'ire n` ;ysfQSrr?s ,7.w 0t vs _PrgWM;1i rortrrs;?M Fromectiim Apo. 07124137