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MA-Y-12-03 14:08 FROM-Colorado Division of Minerals & Geology +13038663567 T-308 P.006/007 F-653 <br />SIGNED, SEALED-AND DATED this day of . <br /> <br />Operator <br />By: <br />Signature <br />Title: _I&Ia? <br />NOTARIZATION OF OPERA.TOXS ACKNOWLEDGMENT <br />STATE OF D w Ac, <br />1 <br />' )Ss. <br />COUNTY OF bit u e? )? - _Da The foregoing instrument was acknowledged bef e me this <br />day of Q Oa , by 6eY i <br />as ©w e-r Ma a of Scene !rf( ?kyeSfeKfsrL„t C? <br />WFILENE G. b OLLER <br />' v°rNi!uSfO NO. 170103 <br />1111A ?Ay GO,4!,''iSS10N EXPIRFS:?b <br />a? ?.J'?j <br />NOTARY PUBLIC j <br />My Commission expires: 6 , <br />APPROVED: <br />State of Colorado <br />Mined Land Reclamation Board <br />Division of s and Geology <br />By- <br />Division Director <br />bate: <br />503F.bnd <br />P1.% M 6 %