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9 (Form 2- Public) <br />V ill. <br />Please place you initials on the line provided: <br />I hetrbv verify that the foregoing infionnation is true and accruate and conunit to the reclamation of the <br />(1? <br />aforementioned prospecting site as required by the Colorado Mined Reclamation Act and the rules as specified in the <br />f had Rock/Metal Mining Rules and Regulations and this NO[ firm. <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 />operation, if the prospecting operation is located on federal public land. <br />I have also enclosed the appropnate reclamation surety amount or will post an amowit as determined by the office, <br />haled on the projected costs of nxlanurUon. <br />I understand that 1 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 />ZswL I accept and agree to comply %vith the foregoing terms and conditions and with all of the provisions of Rules 3 and 5, <br />and l'.R S 3d-32-101. <br />This firm has been approved hp the Alined Larid Reclamation Board pursuant to section 34-32-113, C.R.S., of the Mined Land <br />Reclamation Act. An.i! alteration or modification of this form shall result in voiding an$, A101 issued on the a6ered or modified <br />firm and subject the operator to cease and desist orders and chil penalties for operating without a NUI pursuant to section 34- <br />32-123, C:R.S. <br />1, the wu[ersigned, being the NC)1 holder or the person authorized to sign on behalf of the NOI holder. declare that the information <br />given in this N(11 form is true and correct <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this! day of <br />Signature of N(>I holder or person authorized to sign: <br />L <br />Name (typed or pant) VS-. Mykltta <br />Title/Position Colorado Operations Manager, Unconventional Oil <br />M:'uninla---- sti)rms\U7-U7-111 vsf<mislPros [in+, foimslVl?I I'ros??eolingApp 7!24,'07