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-7- <br /> Cerkfiiicatim: <br /> As an authorized representative of the applicant,I hereby certify that the operation described has met the minimum requirements of the following <br /> terms and conditions: <br /> 1. All necessary approvals from local government have been applied for(Rule 1.62(1)and(2)); <br /> 2. This entire mining operation will not extract more than 70,000 tons of mineral,overburden,or combination thereof in any <br /> calendar year(defined in Rule 1.1(24)); <br /> 3. This mining operation will not adversely affect the stability of any significant,valuable and permanent man-made structurc(s) <br /> located within two hundred(200)feet oftbe affected lands. (However,where there is an agreement between the applicant/operator and <br /> the persons having an interest in the structure that damage to the structure is to be compensated for by the applic antloperator <br /> (Section 34-32-115(4xd),C.RS. 1984,as amended),then mining may occur within 200 feet.Proof of an agreement must be submitted to <br /> 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)(f),C.R.S. <br /> 1984,as amended); <br /> 5. As the applicant/operator,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 deterrnined through a Board finding. <br /> 6. 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.1994,as amended. <br /> This form has been aq ywoved by the Mined Land Reclamation Boardpursuant to section 34-32-110,C.RS.,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 form and <br /> subject the operator to cease and desist orders and civil penalties for operating without a perm#pursuant to section 34-32-123,CJU <br /> Signed and dated this day of <br /> JACK 0 TABB,LLC If Corporation Attest(Seal) <br /> Applicant/Operator <br /> Signed: Signed: <br /> Corporate Secretary or Equivalent <br /> Title: Town/City/County Clerk <br /> State of ) <br /> )ss. <br /> County of 1 <br /> The foregoing instrument was acknowledged before me this day of <br /> by as of <br /> NOTARY PUBLIC <br /> My Commission expires: <br /> SIGNATURES MUST BE IN BLUE INK <br />