Laserfiche WebLink
9 (Form 2- Public) <br />VIII. SIGNATURE .REQUIREMENT <br />.Please place you initials on the line provided: <br />____. _/__~_ __ I hereby verify that the foregoing information is tnic: and accurate and cammit to the reclamation of the <br />V aforementioned prospecting site as required by the Colorada l~lined Reclamation Act and the rules as specified in the <br />hard RockiMetal Mining Rules and Regulations and this NO.I form. ~j <br />I have n ~~'f e~ls~tOss r <br />,___/~~ e closed the required permit fee. ~ /~ <br />/~~~ I authorize the Division to contact and copy the BL1~1 andfor USFS on any correspondence related to the praspecting <br />operarion, if the prospecting operation is located on federal public land. <br />_1~~~'/ I have also enclosed the apprapriate reclamation. surety amount or will post an amount as determined by the office, <br />based an the projected costs of reclamation. <br />._~~~~' / [understand that I am not authorized to create any surface disturbance until the surety amount is pasted and approved <br />~/ in writing from the Division of Reclamation, .lining and Safety. <br />~~i~77_ I accept and agree to comply with the foregoing terms and conditions and with a.ll of the provisions of Rules 3 and S, <br />and C.RS. 34-32-I01. <br />This form har been approved by the 1Kined Land Reclamation Soard pursuant to section 34-32-C13, C R.S, of the Mined Land <br />Reclamation Act. Any alteration or modification of this form sC:alt result in voiding any ,'V(II issued on the aCtered 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 />I the undersigned being the NOT ha_lder or the person authorized to sign on behalf of the Iv'OI holder declare that the information <br />given in this NOI form is true and correct. <br />SIGNATURF,S MUST' BE IN BLUE INK <br />Signed and dated this 1 ~~ <br />day of C~/~ ~- ~4D <br />Signature of NOI holder or person autharized to sign: <br />r <br />'game (typed car print? ._Richard Blubaugh__________ <br />'1'itls.i`Pr?si.tion: V . P . EH&S Resources <br />»Y4r;: haa~.:v~?c:,,.~;~z?s';'-t3'til vstz~$~3~as 1? e3~,~~c~tin~ fc~t;rr7:>'4~)d Yrc~s;btir,,~ tt~g:!}'?%2~.~_"t. <br />