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9 (FORM 2 - Public filing) <br />VIII. SIGNATURE REQUIREMENT <br />Please/,place you initials on the line provided: <br />WA 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 NOT form. <br />A I have enclosed the required permit fee. <br />W 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 />u w,• 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 />id. 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 />A 01 I accept and agree to comply with the foregoing terms and conditions and with all of the provisions of Rules 3 and 5, <br />and C.R.S. 34-32-101. <br />6WA", I herby certify that concurrent with submittal of this NOT to the Division, I have sent notice to the Boards of County <br />Commissioners in the Counties where the proposed activities will occur. This notice also indicated that non- <br />confidential information regarding the proposed activities will be available for review at the Division's website. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32-113, C.R.S., of the Mined Land <br />Reclamation Act Any alteration or modyleation of this form shall result in voiding any N01 issued on the altered or modified <br />form and subject the operator to cease and desist orders and civil penalties for operating without a N01 pursuant to section 34- <br />32-123, GR.S. <br />1. the undersigned- being the NOT holder or the person authorized to sign on behalf of a NOT holder, declare that the information <br />given in this NO form is true and correct. <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this day of M Q t/ Z O l? , <br />Signature of NOT holder or person authorized to sign: <br /> <br />Name (typed or print) 6-114111- w r t O = ? - <br />Title/Position: V/e- / F-,G44L1011-1' j 6e.14 --w41/ X'42^'?j 2 i' <br />