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Agreement to Conduct Permitting by Electronic Means RECEIVED <br /> AUG 2 4 2018 <br /> Name of permittee representative desiring to DIVISION OF RECLAMATION <br /> opt in to ePermit: MINING&SAFETY <br /> Name of permittee: 0,oL-b2A-D0 A i-A-aAjTc--P- c�g ctP-Puy <br /> 6FAur d, doNE6 <br /> Title: D <br /> Signature: <br /> Email Address for ePermit Account: 51n vi eS CD I n Y-0.Az GLl g-h a4e-r, t, trm <br /> Notarized Affidavit of Signature <br /> STATE OF: <br /> COUNTY OF: ) ss. <br /> eir <br /> The foregoing instrument was acknowledged <br /> before me this 3 P� day of Q by <br /> (date) (year) <br /> as <br /> AN c,-- y C ao NC.s 4WIV�,c <br /> (Name of permittee representative) (title) <br /> of ` <br /> (permittee) <br /> SARSARA R KEYSER <br /> NOTARY PUSUC NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20004019M <br /> MY COMMISSION EXPIRES 021r17=M <br /> (seal) <br /> My Commission expires: <br /> Page 3 of 4 <br />