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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 structure(s)located <br /> within two hundred(200)feet of the affected lands. (However,where there is an agreement between the applicant/operator 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 /> 834-32-115(4)(d),C.R.S. 1984,as amended),then mining may occur within 200 feet. Proof of 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 prohibited by law(Section 34-32-115(4)(fl,C.R.S.1984,as <br /> amended); <br /> 3. 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 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 the Mined Land Reclamation Board pursuant to section 34-32-112,C.R.S., 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 <br /> and subject the operator to cease and desist orders and civil penalties for operating without a permit pursuant to section 34-32-123, <br /> C.R.S. -- <br /> Signed and dated this day of <br /> m lm'e 'I V ('1a�' If Corporation Attest(Corporate/County Sea]) <br /> Applicant/Operator Name <br /> Signature: By. <br /> Co 4rate Secretary or Equivalent <br /> Title: Town/City/County Clerk <br /> State of <br /> )ss. <br /> County of <br /> The foregoing instrument was acknowledged before me this 3 day of T�k�k <br /> by t G &iV� � of M L C <br /> LINDA WOODRUFF <br /> NOTARY PUBLIC Notary Public <br /> STATE OF COLORADO <br /> NOTARY ID 19994028269 My Commission expires: <br /> MY COMMISSION EXPIRES 10/07/2027 <br /> 8 <br />