Laserfiche WebLink
9 (Form 2- Public) <br />VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the line provided: <br />G 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 />?SG 1 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 />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. 34-32-101. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32-113, C.&&, 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 modifted <br />form and subject the operator to cease and desist orders and civil penalties for operating without a NOI pursuant to section 34- <br />32-123, C.R.S. <br />I the undersigned, being the NOI holder or the rson authorized to sign on behalf of the NOI holder declare that the information <br />given in this NOI form is true and correct. <br />SIGNATURES MUST BE IN BLUE INK <br />LtV 71-1 Signed and dated this __ day of ?d <br />Sigi j" of NOI holder or person auoo#zed to sign: <br />i <br />Name (typed or prin,/' <br />-- <br />Title/Position: <br />''ISYSti?S?S27k'?6'SfiXIYiY"?!}?? '{}? y5Lt1;91&1pStc in2 forgaVNIOt Noomai gApp (}7PNX7