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9 (Form 2-Public) <br />VIII. SIG[VATURE .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 Hales as specified in the <br />Hard Rock/Metal 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 BLM andlor C;SFS on any correspondence related to the prospecting <br />/~, operation, if the prospecting operation is Located on federal public land. <br />C `/y~~- 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 pasted and approved <br />< i;~~~~ <br />in writing from the Division of Reclamation, Mining and Safety. <br />~~~.~~..,i I accept and agree to comply with the foregoing terms and conditions and with all of the provisions of Rules 3 and 5, <br />C~~ and C.R.S. 34-32-10I. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32-113, C.R.Q., of the Mined Land <br />Reclamation Act Any alteration ar modification of this form shall result in voiding any NOI issued on the altered or modified <br />form and subject the operator to cease and desist orders and civil penalties for operating without a NQI pursuant to section 34- <br />32-123, C.RS. <br />I, the undersigned, beine the NOI holder or the person authorized to sight on behalf of the NOI holder, declare that the information <br />iveg_ n in this NOI form is true and correct. <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this . ~ ~ day of ~-el~i-t~~ ~ ~~ , <br />Signature of NOI holder or person authorized to sign: <br />Name (typed or print) -~d~ ~ . ~.C~U~I L [ ; ~ ____. <br />Title(Position: ~~ C.d<o / S i <br />4:trr~i8 ~.a f 407-0'-0! vsf 1 ^ti `:'*: t tin ~ .07241 'r <br />