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f - <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 />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 <br />any calendar year(defined in C.R.S.34-32-110(2)(a)); <br />3.This mining operation will not adversely affect the stability of any significant, valuable and permanent man-made <br />structure(s) located within two hundred (200) feet of the affected lands. (However, where there is an agreement between the <br />applicant/operator and the persons having an interest in the structure that damage to the structure is to be compensated for by the <br />applicant/operator (Section 34-32-115(4)(d), C.R.S. 1984, as amended), then mining may occur within 200 feet. Proof of an <br />agreement must be submitted to 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 34-32-1150)(t), <br />C.R.S. 1984,as amended); <br />5.As the applicant/operator, l do not have any mining/prospecting operations in this state of Colorado currently in <br />violation of the provisions of the Mined Land Reclamation Act(Section 34-32-120, C.R.S. 1984, as amended) as determined <br />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 <br />herein are punishable as a Class I misdemeanor pursuant to Section 18-8-503,C.R.S 1984,as amended. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32-110(1),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 <br />fours and subject the operator to cease and desist orders and civil penalties for operating without a permit pursuant to section <br />34-32-123, C R.S. <br />LSignedanddatedthis /S day of e s[ 2Qr <br />Stn E I nS (LL If Corporation Attest(Seal) <br />Applicant/Operator <br />Signed B By: <br />Corporate Secretary or Equivalent <br />Title: ?l CoJ€ <br />I _' ( <br />MG.i lG.C t1 Town/City/County Clerk <br />State of AUJC CSC) <br />J ) <br />ss. <br />County of we3.6 - <br />The foregoing instrument was acknowledged before me this / day of cny 010 / <br />JCcasFro IVtc ,Amer of L_L . <br />Notary tublic <br />My Commission expires: // -off a-aO/c <br />STEPHANIE L KEES <br />NOTARY PUBLIC <br />SIGNATURES MIDST BE IN BLUE INK <br />STATE OF COLORADO <br />NOTARY ID#19994011546 <br />MY COMMISSION EXPIRES APRIL 28,24111