Laserfiche WebLink
9 (Forn3 2- Public) <br />is VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the tine provided. <br />I hereby verify that the foregoing information is true and accurate and commit to the teclamation 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 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 and/or USFS on any correspondence related to the prospecting <br />ff operation, if the prospecting operation is located on federal public land. <br />I have also enclosed the appropriate reclamation surety amotnnt 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 />in writing from the Division of Reclamation, Mining and Safety. <br />r 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 />T ais form has been approved by the Mined Laad.Redamadon Board pursuant to section 31-32-113, C.RS., of the Aftned Land <br />Reclamation Act Any alteration or modification of this form shall result in voiding any NOI Issued on the altered or motif-ed <br />form and subject the operator to cease and desist orders and civil penalties for operatio ? without a NQI pursaant to section 3d- <br />32-123, CR.a <br />the d ed bein the NOT bold or the person authorized to sin on behalf of the NOI older dec that the inf _qrmation <br />given in this N01 form, is true and correct <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this 1 day of MA OW <br />` <br />r <br />Signature of NCI holder or person autho ized to sign: <br />/ W <br />"*tanlc (typed x}c pint) <br />`ritlc/Positivn° V <br />elv #erLr u17 7 f1P,_vat ,foY _' .P ILSiL t r t l?StzQT dV7