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-5- <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 terms <br />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 applicanUoperator and the persons <br />having an interest in the stntcnue that damage to the structure is to be compensated for by the applicandoperator (Secflon 834-32-I15(4)(d), <br />C.R.S.1984, as amended), then mining may occur within 200 feet. Proof of an agreement must be submitted to the Office prior to the decision <br />date.) <br />2. No mining operation will belocated on lands where such operations aze prohibited by law (Section 34-32-115(4)(f), C.RS. 1984, <br />as amended); <br />3. As the applicandoperator, 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 (Secti0on 34-32-120, C.R.S. 1984, as amended) as determined through a Boazd finding. <br />4. I understand that statements in the application aze being made under penalty of perjury and that false statements made herein -aze <br />punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S 1984, as amended. <br />Signed and dated this ~ day of ~:a ~! ~ ~~? O ~ , <br />J[d.nN $'lU9 G"i~ `oy ter..: `l^~<ti <br />~ Applican perator or Company Name <br />Signed: h~~ K <br />Title: 1 actor,.., ~a~ l ~ ~~v ~v~.a,- <br />State of _ <br />County of <br />ss. <br />The foregoing insnumen[ was acknowledged before me this <br />IoY <br />If Corporation Attest (Seal) <br />~ . <br />Signed: `~ ~ Y{ 1 /~*~+~W <br />Corporate Secretary ar Equivalent <br />Tovw/City/County Clerk <br />day of , <br />as <br />of <br />Notary Public <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />ponsrzoot) <br />