Laserfiche WebLink
9 (Form 2- Public) <br />V1111. SIGNATURE R-mi rlD rxAv V , <br />Please place you initials on the line provided: <br />I hereby verify that the foregoing information is true and accurate and commit to <br />aforementioned prospecting site as aired b the C.ol the reclamation of the <br />Hard Roc"etal Mining Rules and Regulations and or adNot o a Reclamation Act and the rules as specirted in the <br />I have enclosed the required permit fee. <br />I authorize the Division to contact and Copy the EU4 and/or USFS on an corres <br />operation, if the prospecting operation is located on federal public land, y pondence related to the prospecting <br />I have also enclosed the appropriate reclamation surety amount or will post an amount as determined by the ofI'tce <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 />Afil- I accept and agree to comply with the foregoing terms and conditions and with all of the provisions of Rules 3 and S, <br />and C.R.S. 34-32-101. <br />This farm has been approved by the Mbred Laird Reelamatlon Board pursuant to section 34-31-113, CRS., of the Alined Laced <br />Realamadou Act Any alteration or modiftcarlon of thin form shall resuM In voiding any NOI Issued on the altered or modUkd <br />form and subject the operator to cease and desist orders and civil penalties for operating without a N01 pursuant to seetioa 34- <br />32-123, C.&S. <br />Riven fit this NOi for?+ i trt*e nd Correct <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this <br />day of :? •? , . <br />Signature of NOI holder or person authorized to sign: s <br />'lame (typed or print) <br />"fide/Position,: r'`/ 1..r ?_ra <br />t?``s:d,"rt9fr?s€ipr?ix?:G.L. ti'ytcfi't?'.F_sstp.?t7rrIYSTI..P_'Et<..1?•. ?'}!l?ti?7