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-~- <br />Certification: <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. This mining operation will not adversely affect the stability of any significant, valuable and perrr><~nent man-made structure(s) located <br />within two hundred (200j feet ofthe affected lands. (However, where there is an agreement between the applicant/operatorsnd the persons <br />having an interest in the structtue that damage to the stmcture is to be compensated for by the applicanUopetator (Section 834-32-1 ] S(4)(d), <br />C.It.S. 1984, as amended), then mining may occur within 200 feet. Proof of an agreement must be submitted to the Office prior to the <br />decision date.) <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32-115(4)(f), C.R.S. 1984, as <br />amended); <br />3. As the applicanUoperator,l do not have any mining/prospecting operations in this state of Colorado currently in violafion ofthe provisions <br />of the Mined Land Reclamation Act (Section 34-32-120, C.R.S. 1984, as amended) as determined through a Board fording. <br />4. I understand that statements in the application are being made under penalty ofperyury and that false statements made herein aze punishable <br />as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984, as amended. <br />Thisjorm has been approved bythe Mined Land Reclamation Board pursuant to secdan 34-32-III,C.R.S., ojthe Mined LandReclamatlonAcb <br />Any aUeration or modification ofthisform shall resuk in voiding any permitissued on the a@ered or modified jorm and subjectthe operatorto <br />cease and desist orders and civil penalties jar operating without a permh pursuant to section 3d-32-123, C.RS <br />Signed and dated this 2 ~p day of `~"'^' e , ~"c'~ <br />~:-~~~ ~ ~ ~S ~or7o~a~~On <br />etc ~eS~c.-Rt-It`Cotporati~n Attest (CorlroratelCounty Seal) <br />~A ]icanU erator Naam <br />PP OP <br />sig~~"-~\~``"''~\By. S ~~ ~1C' r~ ~ ~ rt~o rt to <br />Corporate Secretary or <br />Title: e~~ ~ ~°-~r.\t~ ~~i 445w`tiw .!City/County Clerk <br />~~ I ~UCLS <br />/' ~L <br />W <br />~.~ t~~62if'C't ~ <br />~~L ~ <br />ricalent ~~ <br />State of ~ ~""ry'v ~~ Q~ <br />ss. <br />County of~~l+~B~DNj ~.XCCU~'.vCv,t-e.-~~.r~S~~+~~ £ C.bttef- Q~rq~~rq <br />C1~tce ~ <br />t1. / <br />The foregoing insinunent was ackno edged before me thisot6 day of ..yam .7DQ <br />5~eptae,~ P. <br />by ~`'`_ F°`'~Q_as of ~E27~'iY.~NEt_.S~ES©.t-2CES CcXZP~214T1orJ <br />!; .:,. :, <br />~:, <br />'~ \ - <br />-~, ~ c.- _ - ~. <br />.s, y ,i f^'. ~ <br />•~ - - <br />~~_= <br />P~v1t323FD~i,).11'1 (05,"1~N14)~ ~- <br />,... f ~ v <br />~ ~' r ~` <br />~_ ---- <br />c~Lr~ t_tkna,b~n~ <br />Notary Publicp <br />My Commission expires: waif a ~ ~~~ <br />