2010-05-27_PERMIT FILE - P2010011 (4)

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9 (Form 2- Public) Vill. SIGNATURE RE4VIDUN•IENT Please lace you initials on the line provided: 1 hereby verify that the foregoing information is true and accurate and cormnit to the reclamation of the aforementioned prospecting site as required by the Colorado Mined Reclamation Act and the rules as specified in the Bard Rock'Mctal Mining Rules and Regulations and this N01 form. I have enclosed the required permit tec. I authorize the Division to contact and copy the BLIM and/or USFS on any correspondence related to the prospecting operation, if the prospecting operation is located on federal public land. 1 have also enclosed the appropriate reclamation surety amount or will post an amount as determined by the office, based on the projected costs of reclamation. 1 understand that I am not authorized to create any surface disturbance until the surety amount is posted and approved in writing from the Division of Reclamation, Mining and Safety. I accept and agree to comply with the foregoing terns and conditions and with all of the provisions of Rules 3 and 5. and C.R.S. 3432-101. this farm has been approved btu the Alined Land Reclamation hoard pursuant to section 34-32-113, C.R.S, of the Alined Land Reclamation Aci. Ani, alteration or modification of this form shall result in voiding ant' ,x'01 issued on the altered or rnodifred form and subject the operator to cease and desist orders and civil penalties for operating without a N01 pursuant to section 34- 32-123, C.R.S. i,_the untigsigned, beitgthe Nnl holder or the person authorized to sign on behalf of the NOI holder, declare that the information -given in this NOi form is true and correct. SIGNATURES MUST BE IN BLUE INK Signed and dated this O???_ day of Signature of NO] holder or person authorized to sign: Name (tN°prd Cr priratj _Richard Blubaugh Title Position: V.P. EH&S Resources