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-7- <br /> Certification: <br /> As an authorized representative of die applicant. I 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. "Ihis 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 34-32-115(4)(t), <br /> C.R.S. 1984,as amended); <br /> 5. As the applicant/operator, I 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. 1 understand that statements in the application are being made under penalty of perjury and that Use statements made <br /> herein are punishable as a Class l 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 modifcation of this form shall result in voiding any permit issued on the altered or modified <br /> firm 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 day of <br /> If Corporation Attest(Seal) <br /> pplicant/Operator <br /> 7 <br /> Signed By: /�//�f/�ZG /�[J �C� By: <br /> ? Corporate Secretary or Equivalent <br /> -ram Title: Town/City/County Clerk <br /> State of (2 y /o rct o } <br /> )5S. <br /> County of C-h a r rc"— } <br /> The foregoing instrument rajas acknowledged before me this day of b 1 , <br /> by as G ram.��.fl i d s� of .0 G P031" en rt <br /> D BBIE ANOTARY SPAU8lAZAR LIC k� <br /> STATE OF COLORADO otary Public <br /> NOTARY ID 20034031254 y Commission expires: 6Cl' j 7— .2DI 9 <br /> My Commission Expires W17-2019 <br /> SIGNATURES MUST BE IN BLUE INK <br />