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Certitieatlon: <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 applicantroperator 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-l 15(4)(d),C.R.S. 1984,as amended),then mining mayoccur within 200 feet. Proofof 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 prohibitedby law(Section 34-32-t 15(4)(1),C.R.S. 1984,as <br /> amended); <br /> 3. As the applicantroperator, I do not have any mining/prospecting operations in this state of Colorado currently in violation of the <br /> provisions of the Mined Land Reclamation Act(Section 34-32-120,C.R.S. 1984,as amended)as determined through a Board finding. <br /> 4. 1 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 fire Mined Lard Reclamation Board pursuant to section 34-32-11 Z,C R.S., of the Mined Card <br /> Reclamation Act Aire alteration or modification of this form shall r estttt in voiding anJ,per►rrit is,vued on the altered or modified fo rrn <br /> rind subject the operator to cease and desist orders and civil penalties for operating withouta permitpursuant to section 34-32-123, <br /> C.R.S. <br /> Signed and dated this� day ofNoyetnh er , 2 0 2-1 <br /> Ouray Silver Mines, Inc. If Corporation Attest(Corporate/County Sea]) <br /> Applicant/ e aa. T <br /> Brian K. Briggs <br /> Signature: lid: <br /> Corporate Secretary or Equivalent <br /> f ftic: O Town/City/County Clerk <br /> State oft, . ) <br /> ss. <br /> County of <br /> 11� <br /> The foregoing instrument was acknowledged before tie this 1 day of 2-02-1 <br /> by as of <br /> r <br /> Notary Public <br /> CHERYL MELINO My Commission expires: <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20194030332 8 <br /> MY COMMISSION EXPIRES 07/27/2022 <br />