Laserfiche WebLink
9 Womi _'- Public) <br />VIII. SIGNATURE REOL IRENIENT <br />Please place you initials on the line provided: <br />) <br />Cry I hereby %crity that the foregoing information is uue and accurate and commit to the reclamation of the <br />J afoicnientioned prospecting site as required by the Colorado Mined Reclamation Act and the rules as specified in the <br />I lard Rock Metal Mining Rules and Regulations and this NO[ Corm. <br />I have enclosed the required permit flee. <br />I authorize the Division to contact and copy the 131-M and or t:SGS on any correspondence related to the prospecting <br />operation, if the prospecting operation is located on federal public land. <br />1 <br />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 <br />'IV I understand that I am not authorized to create any surface disturbance until the surety amount is posted and approved <br />% in writing front the Division of Reclamation, Mining an(] Sate(y. <br />(I <br />?" rl y I accept and agree to comply with the foregoing terms and conditions and with all of the provisions of Rules 3 and S. <br />-? and C.R.S. 3d-32-101. <br />This jorm has been approved nr, the Alined Laird Reclamation Board prtrsttant to section 3d-32-113, C.R.S., o% the Mined Laird <br />Reclamation Act. Anv alteration or nrodi/rration of this J)rn? shall result in voiding aig :VOf issued nn the altered or modified <br />jorin card.sabject the operator to cease and desist order% and civil penalties for operating without a V01 pursuant to section 34- <br />32-123, C.R.S. <br />[, the undenttn_cd, being: the \( )I holler or the erson authorized to sign on hehalfof die_NQI holder, declare that the information <br />givcn.in this N01 form. is true :end Cot_Tect. - <br />SIGVA I I'RES NIL S•1' BE IN BLI E INK <br />Signed and dated this day of C)_ <br />Signature of \01 holder or person authorized to sign: <br />i <br />\arne (typed or print) j(20 <br />Fide, Position: ?/r D 4-,::-, <br />nimshaic tsti)r:7G(li4)?jl1 csti+nr ,i'm?pcimty t01Ub VUl Pn?speCUlie. App 0 ' X40