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THE INFORMATION ON THIS PAGE DOES NOT NEED TO BE HELD CONFIDENTIAL <br /> 9 RECEIVED <br /> VIII. SIGNATURE REQUIREMENT JUL 0 12008 <br /> GRAND JUNUI FiELDOFFICE <br /> DIVISIPlease place you initials on the line provided; <br /> RECLAMATIONMOI�+N�F&SAFETY <br /> I 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 NOI 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 prospecting operation is located on federal public land. <br /> I have also enclosed the appropriate reclamation surety amount or will post an amount as determined by the officer <br /> based on the projected costs of.reclamation. <br /> 1 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 /> I 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-I01. <br /> This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32-113,C:RS.,of the Mined Land <br /> Reclamation Act. Any alteration or modification of this form shall result in voiding any NO1 issued on the altered or modified <br /> form and subject the operator to cease and desist orders and civil penalties for operating without a N01 pursuant to section 34- <br /> 32-123,C.R.. <br /> I the undersigned being the NOI holder or the person authorized to sign on behalf of the NOI holder,dE:clare that the information <br /> given in this NOT form is true and correct. <br /> SIGNATURES MUST BE IN BLUE INK <br /> Signed and dated this c> 0 day of J y/✓t� ZDdB <br /> Signature of NOI holder or person authorized to si : <br /> Name(typed or print) Pe c E�_p T: i&Y <br /> i' _ <br /> Title/Position: V opn w T/O/V 5 <br /> hmin\sh ysfornt t07-Q7-01 vs&o,bg`'Pr tins fim_MNOI Prospecting Attu 07/24.107 <br /> i� <br /> - 1 <br /> a <br />