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-8- <br /> Certification: <br /> As an authorized representative of the applicant,I hereby certify that the operation described has met the minimum requirements of the <br /> following terms and conditions: <br /> 1. This mining operation will not adversely affect the stability of any significant,valuable and permanent man-made structure(s) <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 34-32-115(4)(f),C.R.S. <br /> 1984,as amended); <br /> 3.As the applicant/operator,I do not have any mining/prospecting operations in this state ofColorado currently in violation ofthe <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 heen approved by the Mined Land Reclamation Board pursuant to section 34-32-112,C.R.S., of the Milled Land <br /> Reclamation Act. Any alteration or modification ofthisform shall result in voiding ar{yperrrdt issued on the altered ornrodifredform <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 t { day of <br /> Cripple Creekr'&yictor Godd Mining Company If Corporation Attest(Corporate/County Seal) <br /> Appli an'Operator ame <br /> a <br /> Signature: 1 - — By: <br /> Gene f Manag r Corporate Secretary or Equivalent <br /> Title: Town/City/County Clerk <br /> r� r <br /> State of <br /> )ss. <br /> County of <br /> The foregoing instrument was acknowledged before me this �4 r t day of <br /> UTAR <br /> 4 _ ;on 1\ Notary Public <br /> �, PUg�tG My Commission expires: <br /> C01- <br />