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C -00T I/ 247 RECEIVED <br />An example Structure Agreement which meets the requirements of the Statutes is shown below. <br />********************.**************, *** :**:: ***********************************'fir `14 2015 <br />Structure Agreement <br />Division of Reclamation, <br />Mining & Safety <br />This letter has been provided to you as the owner of a structure on or within two hundred (200) <br />feet of a proposed mine site. The State of Colorado. Division of Reclamation, Mining and Safety <br />("Division") requires that where a mining operation wiII adversely affect the stability of any significant, <br />valuable and permanent man-made structure located within two hundred (200) feet of the affected land. <br />the Applicant shall either: <br />a) Provide a notarized agreement between the Applicant and the Person(s) having an interest in the <br />structure, that the Applicant is to provide compensation for any damage to the structure; or <br />b) Where such an agreement cannot be reached, the Applicant shall provide an appropriate <br />engineering evaluation that demonstrates that such structure shall not be damaged by activities <br />occurring at the mining operation; or <br />c) Where such structure is a utility, the Applicant may supply a notarized letter, on utility letterhead, <br />from the owner(s) of the utility that the mining and reclamation activities. as proposed, will have <br />"no negative effect" on their utility. ( Construction Materials Rule 6.3.12 and Rule 6.4.19 & Hard <br />Rock/Metal Mining Rule 6.3.12 and Rule 6.4.20) <br />The Colorado Mined Land Reclamation Board ("Board") has determined that this form, if <br />properly executed, represents an agreement that complies with Construction Materials Rule 6.3.12(a), <br />Rule 6.4.19(a), and C. R.S. S 34-32.5-115(4)(e) and with Hard Rock/Metal Mining Rule 6.3.12(a), Rule <br />6.4.20(a), and CR.S. 34-32-115(4)(d). This form is for the sole purpose of ensuring compliance with the <br />Rules and Regulations and shall not make the Board or Division a necessary party to any private civil <br />lawsuit to enforce the terns of the agreement or create any enforcement obligations in the 13oard or the <br />Division. <br />2. <br />3. <br />4. <br />5. <br />The following structures are located on or within 200 feet of the proposed affected area: <br />C T OT H lily 2Y 7 - <br />(Please list additional structures on a separate page) <br />