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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)located <br /> within two hundred(200)feet of the affected lands. (However,where there is an agreement between the applicant/operator and the <br /> persons having an interest in the structure that damage to the structure is to be compensated for by the applicant/operator(Section <br /> 834-32-115(4)(d),C.R.S. 1984,as amended),then mining may occur within 200 feet. Proof of an agreement must be submitted to the <br /> 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.1984,as <br /> amended); <br /> 3. As the applicant/operator, I do not have any mining/prospecting operations in this state of Colorado currently in violation of the <br /> provisions ofthe Mined Land Reclamation Act(Section 34-32-120,C.R.S. 1984,as amended)as determined through a Board 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 been approved by the Mined Land Reclamation Board pursuant to section 34-32-112,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 fo rm <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 /> Sisned and dated this 22 day of February 2021 <br /> Union Milling CornE n If Corporation Attest(Corporate/County Seal) <br /> App " ant Operator Name <br /> Si ture: By: <br /> Member Corporate Secretary or Equivalent <br /> Title: Town/City/County Clerk <br /> State of ee'jmaAG o ) <br /> )ss. <br /> County of <br /> The foregoing instrument was acknowledged before me this day of <br /> by 1Gh0`0.6 as &of L"'(M I.JU4 <br /> l�'LI C I�Cut C o►�t�tC-�V'�S <br /> Notary u lic <br /> ANNA SCHIMBERG OAS L ZGZN <br /> NOTARY PUBLIC My Commission expires: <br /> STATE OF COLORADO <br /> NOTARY ID 2020402M' 8 <br /> MY COMMISSION EXPIRES 06f18/2024 <br />