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-8- <br /> 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 <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 <br /> the applicant/operator(Section 34-32-1 t 5(4)(d),C.R.S. 1984,as amended),then mining may occur within 200 feet. Proof of <br /> an agreement must be submitted to the Office prior to the decision date.) <br /> 2. No mining operation will be located on lands where such operations are prohibited by law(Section 34-32-1 l5(4)(f), <br /> C.R.S. 1984,as amended); <br /> 3. 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 /> 4. 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 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,CR.S., of the Alined Land <br /> Reclamation Act. Any alteration or modification of this form shall result in voiding any permit issued on the altered or modified <br /> farm and subject the operator to cease and desist orders and civil penalties for operating without a permit pursuant to <br /> section 34-32-123, C.R.S. <br /> Signed and dated this `P day of rL��Z_- <br /> IHC Scott, Inc. (dba Scott Contracting, Inc.) <br /> If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name <br /> Si <br /> orate Secreta. nklivalent <br /> Cot wn/City/County Clerk <br /> Title: <br /> State of ���r� ) <br /> SEAS, <br /> ss. <br /> County of ) /G'H�GP� <br /> ..........I I t 11111111111\11\ <br /> The foregoing instrument was acknowledged before me this fl day of <br /> by ' :s �► As as �)\C� �Q �� of �� Q(LL � <br /> KYMBERLY J METCALF <br /> NOTARY PUBLIC Nota ublic <br /> State of Colorado <br /> Notary ID#20194034257 <br /> M Commission Expires 09/06/2023 My Commission expires: <br /> IGNATURES MUST BE IN BLUE INK <br />