The verified statement shall be verified by the operator or by someone in his or her behalf and shall contain all of the following information:
- (a) A description of the ground proposed to be mined by placer mining methods, described by United States government subdivisions if possible.
- (b) The names and addresses of the owners of the ground.
- (c) The names and addresses of the operators of the mine.
- (d) The proposed means or method of placer mining operation.
- (e) The means which the operator proposes to use to prevent the pollution of any stream by the effluent from the operations.