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-6- <br /> Certification: <br /> As an authorized representative of the applicant,I hereby certify that the operation described has met the minimum requirements of <br /> the following terms and conditions: <br /> 1. All necessary approvals from local government have been applied for(Section 34-32.5-11 1(l)(a)(IX)); <br /> 2. This entire mining operation will not affect more than 30 acres; <br /> 3. 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 <br /> the applicant/operator and the persons having an interest in the structure that damage to the structure is to be compensated <br /> for by the applicant/operator(Section 34-32.5-115(4xe),C.R.S.1984,as amended),then mining may occurwithin 200 feet. <br /> Proof of an agreement must be submitted to the Office prior to the decision date.) <br /> 4. No mining operation will be located on lands where such operations are prohibited by law <br /> (Section 34-32.5-115(4xf),C.R.S. 1984.as amended); <br /> 5. As the applicant/operator,I do not have any mining/exploration operations in this state of Colorado currently in <br /> violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials <br /> (Section 34-32.5-120,C.R.S. 1984,as amended)as determined through a Board finding. <br /> 6. I understand that statements in the application are being made under penalty of perjury and that false statements <br /> made herein are punishable as a Class I 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 34-3Z5-III,C.R.S.,of the Colorado <br /> Land Reclamation Art for the Evraction of Construction Materials. Any alteration or modification of thisform shall result In <br /> voiding any permit issued on the altered or modified for►n and subject fire operator to cease and desist orders and civil penalties <br /> for operating without a permit pursuant to section 34-32.5-123,C.R.S. <br /> Signed and dated this day of J� "`• oZ 3 <br /> 1HC Scott, Inc. If Corporation Attest eal) <br /> Applicant/Operator <br /> By: tvI r>c✓1' By: <br /> Vice resident Corporate Secretary or Equivalent <br /> Title: f Town/City/County Clerk <br /> State of <br /> )ss. <br /> County of I ) <br /> The foregoing instrument was acknowledged before me this day of <br /> b 'T as 0itt L51Gtvw1� of , S1#4+ �t <br /> y <br /> MITZI REECE <br /> Notary Public Notary ubl� lic 1 <br /> State of Colorado <br /> Notary ID 0 20184011940 My Commission expires: � / mot- � L L)-( <br /> M Commission Expires05-09-2026 ' <br /> SIGNATURES MUST BE IN BLUE INK <br />