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THE INFORMATION ON THIS PAGE DOES NOT NEED TO BE HELD CONFIDENTIAL <br /> 9 RE"'EUVED <br /> VIII. SIGNATURE REQUIREMENT JUL 0 12008 <br /> GRAND,JuNu i MELD OFFICE <br /> DIVISION F <br /> Please place you initials on the tine provided: <br /> RECLAMATIONMIINi G&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 office, <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 /> 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 /> This form has been approved by the Mined Land Reclamation Roard pursuant to section 34-32-113,C..R.S.,of the Mined Land <br /> Reclamation Act. Any alteration or modification of this form shall result in voiding any NOI 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 A.S. <br /> [ the undersigned,being the NOl holder or the person authorized to sign on behalf of the NOI holder,declare that the information <br /> ,given in this NOI farm is true and correct. <br /> SIGNATURES MUST BE IN BLUE INK <br /> Signed and dated this J 0 day of J Umc ZOO( <br /> Signature of NOI holder or person authorized to z <br /> 8�1 -- <br /> Name(typed or print) 9d c Et? L• 7:;>A Y �_-- <br /> Title/Position: V p opEe,4 Tlo,.V S <br /> 1: hay;v t 7 7-0t vsfqmiskPmsDecting A rms!N t hros <br /> pt,gingApp.07/2410 <br /> i <br /> i <br />