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(ACT 0 7 2022 <br /> �}SI <br /> �,11N`NG AND SAMfy <br /> An example Structure Agreement which meets the requiremeats of the Statutes is shown below. <br /> ****�**•s******s�s�e#*�.***:•�*s�*ss#�*s«**.***�*�**:�**�*�***s�*s***«se**se*s********** <br /> Structure Agreement <br /> This letter has been provided to you as the owner of a structure on or within two hundred(200) <br /> feet of a proposed mine site.The State of Colorado,Division of Reclamation,Mining and Safety <br /> ("Division'j requires that where a mining operation will adversely affect the thatof they ofnaffected land, <br /> valuable and permanent man-made structure located within tw o hundred( )) <br /> the Applicant shall either: <br /> a) Provide a notarized agreement be the Applicant and the Person(s)having an interest in the <br /> structure,that the Applicant is to provide compensation for any damage to the structure;or <br /> b) Where such an agreement cannot be reached,the Applicant shall provide an appropriate <br /> engineering evaluation that demonstrates that such structure shall not be damaged by activities <br /> occurring at the mining operation;or <br /> c) When such structure is a utility,the Applicant may supply a notarized letter,on utility letterhead, <br /> from the owner(s)of the utility that the mining and reclamation activities,as proposed,will have <br /> "no negative effect"on their utility.(Construction Materials Rule 6.3.12 and Rule 6.4.19&Hard <br /> Rock/Metal Mining Rule 6.3.12 and Rule 6.4.20) <br /> The Colorado Mined Land Reclamation Board("Board")has determined that this form, if <br /> properly executed, represents an agreement that complies with Construction Materials Rule 6.3.12(a), <br /> Rule 6.4.19(a), and C.R.S. §34-32.5-115(4)(e)and with Hard Rock/Metal Mining Rule 6.3.12(a),Rule <br /> 6.4.20(a), and C.R.S §34-32-115(4)(d). This form is for the sole purpose of ensuring compliance with the <br /> Rules and Regulations and shall not make the Board or Division a necessary party to any private civil <br /> lawsuit to enforce the terms of the agreement or create any enforcement obligations in the Board or the <br /> Division. <br /> The following structures are located on or within 200 feet of the proposed affected area: <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> (Please list additional structures on a separate page) <br />