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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)(1),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. 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. 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 fo rm <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 1 day of A01i ,_� . <br /> • N 0kpLI tVP /N)t If Corporation Attest(Corporate/County Seal) <br /> Applicant/Operator Name <br /> Signature: y' '4 jil <br /> /0 5:C.:( ��/r 7 <br /> Co ate Secret. alent <br /> Title: t k-5I MOT Town/City/County Clerk <br /> State of O 11 ) <br /> )ss. <br /> County of 64LT 1 ) <br /> 14 t, <br /> The foregoing instrument was acknowledged before me this day of AJ,'1 V? , <br /> by.469*0f k64E 1 f'FI( V-"! klcata. hW. <br /> " w JOHN ECKERSIEV �� 46 <br /> /� <br /> • Nit)",! <br /> 1" A No <br /> Public State of Utah 4No <br /> ,�% . r lic <br /> Comm.No. 737290 ,(My Commission Expires on �,1, <br /> "•-' Jul 15,2028 MyCommi en expires: AJL)1 7 w <br /> 8 <br />