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-8- <br /> Certification: <br /> As an authorized representative of the applicant,1 hereby certify that the operation described has met the minimum requirements of the <br /> following terms and conditions: <br /> I. This mining operation will not adversely affect the stability of any significant,valuable and permanent man-made structure(sl <br /> located within two hundred(200)feet of the affected lands. (However,where there is an agreement between the applicant/operator <br /> and the persons having an interest in the structure that damage to the structure is to be compensated for by the applicant/operator <br /> (Section 834-32-115(4)(d),C.R.S. 1984,as amended),then mining may occur within 200 feet. Proof of an agreement must be <br /> submitted to the Office prior to the decision date.) <br /> 2. No mining operation will be located on lands where such operations are prohibited by law(Section 34-32-I 15(4)(f).C.R.S. <br /> 1984.as amended): <br /> 3. As the applicantioperator.I do not have any mining/prospecting operations in this state of Colorado currently in violation of the <br /> provisions of the Mined Land Reclamation Act(Section 34-32-120,C.R.S. 1984.as amended)as determined through a Board <br /> finding. <br /> 4. I understand that statements in the application are being made under penalty of perjury and that false statements made herein are <br /> punishable as a Class 1 misdemeanor pursuant to Section 18-8-503,C.R.S. 1984.as amended. <br /> This form has been approved by the Mined Lund Reclamation Board pursuant to section 34-32-112,CR.S., of the Mined Lund <br /> Reclamation.4ct. Any alteration or modification of this form shall result in voiding any permit issued on the altered or modiftedform <br /> and subject the operator to cease and desist orders and civil penalties for operating without a permit pursuant to section 34-32-123, <br /> C.R.S. <br /> Signed and dated this % ( day of rjC(� �i .c . <br /> Cripple Creek&Victor Gold Mining Company(CC&V) If Corporation Attest(C'orporate'County Seal) <br /> Applicant/Operator Name <br /> ,;/,7"/ <br /> 1 <br /> Signature: /�i3� . . .— -f . ,i.' Ut+-. By: <br /> `- <br /> Corporate Secretary or Equivalent <br /> Title: Vice President of Anglogold Ashanti (Colorado)Corp. & Town'City'County Clerk <br /> General Manager of Cripple Creek&Victor Gold Mining Company <br /> State of ��6 C L ► <br /> )ss. <br /> County of ', t�f� '✓ 1 <br /> The foregoing instrument was acknowledged before me this �' day of c'�t 1(t(z�G� /„ <br /> by /�cL),'Y\:A;`_� ')S as I rr � of_Ci_- d!rY1r 4i n u c« 'c.b11) <br /> tary Public <br /> oC1A0 . , <br /> • N moo. O My Commission expires: >/ 'C� /'/_ v/i <br /> � <br /> 7 PUBLIC 'X' L, cy_ <br /> `% OF CC- <br />