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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 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 Rock/Metal dining 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 B.LM andlor USFS on any correspondence related to the prospecting <br />operation, if the prospecting operation is located on federal public land. I have also enclosed the appropriate reclamation surety amount or will post an amount as determined by the <br /> 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, Mining 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 ;Vined Land Reclamation Board pursuant to section 34-32-113, C.R.S., of the Mined Land <br />Reclamation Act Any alteration or 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 NOI pursuant to section 34- <br />32-123, C.R.S. <br />I, the undersigned, being the NOT holder or the person authorized to sien on behalf of the NOl holder declare that the information <br />given in this NOT .form is true and correct <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this day of //'Ve't ZOO 9 <br />Signature of NOI holder or person authorized to sign: <br />Name (typed or print) Richard__Blubau h <br />fitleiPosition: V . P . EH&S Resourc <br />S;;iri'shei?.:Y19rn1%.3% 11.}'?ts?i'l'3RsnCcn'rr?vt?S, Nn?c?tiE:?,-: Pte!°.?{. 17