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9 (Forn12- Public) <br />VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the line provided: <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 RocklMetal 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 BLINI 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 detennined 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, ;dining 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 34-32413, C.R.S., of the Mined Land <br />Reclamation Act Any alteration or modification of this form shall result in voiding any 1VOI issued on Ilse altered or modified <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 />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_NOI form is true and correct. <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this _ day of , <br />Signature of NOI holder or person authorized to sign: <br />pan-w. (typed or print? -Richard Blubau h <br />V.P. EH&S Resources <br />A