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Certification: <br />286455 12/13/2017 02:57 PM 8: 943 P: 296 LOC CT <br />Paye 8 of 25 R $133.25 0 $0.00 T $133.25 Clear Creek <br />1111 I� PAWWrilip, 429h 11111 <br />As an authorized representative of the applicant, 1 hereby certify that the operation descnbcd has met the minimum requirements of the <br />follo%ing terms and conditions: <br />I . All necessary approvals from local government ha-, a been applied for (Rule l .6.2(1) and (2)), <br />2. This entire mining operation %rill not extract more than 70,000 tons of mineral, o%crburden, 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. (Howe%er, 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 14-32-115(4)(f). <br />C.R.S. 1984, as amended); <br />5, As the applicam operator, i do not have any mini ng/prospccting operations in this state of Colorado currently in <br />violation of the provisions of the Mined Land Reclamation Act (Section 3.3-32-120. C.R.S. 1984, as amended) as determined <br />through a Board Finding. <br />6. 1 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 :fined Land Reclamation Board pursuant to section 34-32-1 10(l) ,CR.S., of the Mined Land <br />Reclamation Act. An), alteration or modification of this form shall result in voiding on), permit issued an fire altered or modified <br />form 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 />Signed and dated this <br />h day of Z G t <br />S Sc-- J f(V J <br />Applicant.IIOpe[r`ator nn <br />By: co <br />State of iGc-L �U ) <br />} ss. <br />County of Ec- _ ) <br />If Corporation Attest (Seal) <br />M <br />Corporate Secretary or Equivalent <br />To%WCity.'Counry Clerk <br />The foregoing instrument was acknowledged before me this w �. P -N day of ) L <br />by 4 G x[. _as H v of <br />n <br />KYR,4N WMCZYK Notary <br />STATAY PIC <br />TE OF COLORADO My Co <br />NOTARY 1D 20164040967 SIGNATURES MUST BE IN BLUE INK <br />MY Commission DOM 10-26-2020 <br />