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9 (Form 2- Public) <br />VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the line provided: <br />I hereby verify that the foregoing information is true and accurate and commit to the reclamation 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 NO.I form. <br />I have enclosed the required permit fee. <br />I authorize the Division to contact and copy the BLM and/or LSFS 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 appropriate reclamation surety amount 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 posted and approved <br />in writing from the Division of Reclamation, Mining and Safety, <br />I accept and agree to comply with the foregoing terms and conditions and with all of the provisions of Rules 3 and S, <br />a.nd C.R.S. 34-32-101. <br />This form has been approved by the Mined Land Reclamation Boardpursuant to section 34-32-113, C.R.&, of the Mined Land <br />Reclamation Act. Any alteration or modification of this form shall result in voiding any JVOI issued on the altered or modified <br />form and subject the operator to cease and desist orders and civil penalties for operating without a NOI pursuant to section 34- <br />32-123, C.R.S. <br />I, the undersigned, being the NOT holder or the person authorized to sign on behalf of the NOI holder, declare that the information <br />given in this NOT form is true and correct. <br />SIGNATURES UST BE IN BLUE INK <br />Signed and dated this _ day of <br />Signature of NOI holder or person authorized to si <br /> <br />Name (typed or print) ._Richard Blubaugh <br />I'itlePositicas: V . P . EH&S Resources <br />.,:47? .1?4.?;7?'n`i}?'{.?::..-fk1 4Sf+,.?,m'43. i?t3?t.r4 ET1Elt lit-'.„ Tt3's.°._:i741g„t1.7-p. S}7i?-r_t