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-7- <br /> Certification: <br /> As an authorized representative of the applicant,I hereby certify that the operation described has met the minimum requirements of the following <br /> terms and conditions: <br /> 1. All necessary approvals from local government have been applied for(Rule 1.6.2(1)and(2)); <br /> 2. This entire mining operation will not extract more than 70,000 tons of mineral, overburden, or combination thereof in any <br /> calendar year(defined in Rule 1.1(24)); <br /> 3. 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 and <br /> the persons having an interest in the structure that damage to the structure is to be compensated for by the applicant/operator <br /> (Section 34-32-115(4)(d),C.R.S.1984,as amended),then mining may occur within 200 feet. Proof of an agreement must be submitted to <br /> the Office prior to the decision date.) <br /> 4. No mining operation will be located on lands where such operations are prohibited by law(Section 34-32-115(4)(0,C.R.S. <br /> 1984,as amended); <br /> 5. As the applicant/operator,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 finding. <br /> 6. 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 Land Reclamation Boardpursuant to section 34-32-110,C.R.S.,of the Mined Land <br /> Reclamation Act. Any alteration or modification of this form shall result in voiding any permit issued on the altered or modified form and <br /> subject the operator to cease and desist orders and civil penalties for operating without a permit pursuant to section 34-32-123, C.R.S. <br /> c r) '­'� . <br /> Signed and dated this �I day of J ie' �'J00 Rr , <br /> A L 5 �—\ L L G If Corporation Attest(Seal) <br /> ApplicVt/Operator <br /> Signed Signed: <br /> Corporate Secretary or Equivalent <br /> Title: M �G Town/City/County Clerk <br /> State of C-0 <br /> (�rw,& r \ )SS. <br /> County of ) r /, <br /> The foregoing instrument was acknowledged before me this ` day of 5,ep�ernbeJ` c�() 1-7 <br /> by q k I as rYve rn be r of lLie- 4 <br /> NO ARY P I <br /> MARY JO MARVEL My Commission expires: Z 12-a Z <br /> NOTARY PUBLIC SIGNATURES MUST BE IN BLUE INK <br /> STATE OF COLORADO <br /> NOTARY ID#20054028754 <br /> Ir1Ir Commission Ermines July 21,2021 <br />