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.