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9 (Form 1 - Att information for DBMS use and confidential .feting) <br />VIII. SIGNATURE REQUIREMENT <br />Plea/setp~lac~e you initials an the line provided: <br />~~ ~_%" I hereby verify that the foregaing information is true and accurate and commit to the reclamation of the <br />aforementioned prospecting site as required by the Colorado :4iined Reclamation Act and the rules as specified in the <br />1lard Rock;'~tetal Mining Rules and Regulations and this NOI forni. <br />.~`~ I have enclosed the required permit fee. ~.SZ~f fJI'~V/IdIS~Y <br />_ ,!~~~_! I authorize the Division to contact and copy the B.LI~i andi`or CJSFS on any correspondence related to the prospecting <br />operation, if the prospecting operation is located on federal public land. <br />1'~'~ .! I have also enclosed the appropriate reclamation surety amotutt 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, ii1-fining 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. 34-32-1.01. <br />This form has been approved by the ~tilined Land Reclamation Boardprrrsuant to section 34-32-113, C.X.S., of the M1lined Land <br />Reclamation Act. Any alteration or modification of this form shall result in voiding any NOI issued orr the altered or mndified <br />form and srtbject the operator to cease and desist orders and eivll penalties far operating without a e'VOI pursuant to section 3~t- <br />32-123, C.R.S. <br />}, the undersigned beintr the NOI holder or the person authorized to si Zg2i on behalf of the NOI holder,. declare that die information <br />liven in t}tis NOI form is true and correct <br />SIGNATURES MC,iST BE Ii`T BLUE INK <br />Signed and dated this 1~'~` <br />day of _ ~~ ZOd 8 <br />Signature of NOI holder or person authorized to sign: <br />-/~v~~%L <br />4ante (typed orprint~t _Rchard Blubaugh _ _ __ <br />`T`itle::%Pc>sitit)n. V . P . EH&S Resources <br />.nn ~;ha.°e`.~~(<<~.m~+~s.~ -t}7-eft v~ ~,r..rt~s ~'rc.:x~t_c~1t~+«rrr~;;'r(}_~'1:LS~~S~,tiT.s.~-;~~;~ cZi:~4r,~3~' <br />