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.• ~ • <br />-4- <br />As an authorized representative of the applicant, I hereby certify that the operation <br />described herein has met the minimum requirements of the following terms and conditions: <br />1. This mining operation will not adversely affect the stability of any <br />signi•Ficant, valuable and permanent man-made structure(s) located within <br />two hundred (200) feet of the affected lands. However, where there is an agreement <br />between the applicant/operator and the persons having an interest in the structure <br />that damage to the structure is to be compensated for by the applicant/operator <br />(C.R.:i. 34-32-115(4)(d)), then mining may occur within 200 feet. Proof of an <br />agreement mrst be submitted to the Division prior to the decision date. <br />2. No mining operation will be located on lands where such operations are <br />prohibited by law (C.R.S. 34-32-115(4)(f)); <br />3. As the applicant/operator, I do not have any mining/prospecting operations in <br />this >tate of Colorado a rrently in violation of the provisions of the Mined Land <br />Reclamation Act (C.R.S. 34-32-120) as determined through a Board finding. <br />4. I understand that statements in the application are being made under penalty <br />of perjury and that false statements made herein are punishable as a Class 1 <br />misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated thi s ~ day of ~ U~ , //~pf . <br />Applic nt/Operator <br />gy: ~~ <br />Ti e: ir,~. <br />State of (? V 0 ) <br />ss <br />County of - ~ U ) <br />If C~or-por~ation Attest (5e al ) <br />Corporate Secretary o+ Equivd.ient <br />?cwn/City/County Clark <br /> <br />The forergo`ing instrvJ~ent was acknowledged beLfore me this ~~day of ~U I~/ ,(~, <br />by ~~~+n~ ~ ~'tl yQ'Py' as ~(~ Ps~l~pnl f _ of ~Q~_~.`I'~"r7".__' <br />~- <br />V-- <br />Notary Public <br />My Commission expires: ~' IJ~ U ~9Q <br />2823E (03/91 ) <br />