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-~- <br />Certification: <br />A9 an authorized representative of the applicant, I hereby certify that the operation described has <br />met the minimum requirements of the following terms and conditions: <br />1. This mining operation will not adversely affect the stability of any significant, valuable <br />and permanent man-made structure(s) located within two hundred (200) feet of the affected <br />lands. (Flowever, where there ie an agreement between the applicant/operator and the persona <br />having an interest in the structure that damage to the structure is to be compensated for by <br />the applicant/operator (Section 834-32-115 (4)(d), C.R.S. 1984, as amended), then mining may <br />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 <br />(Section 34-32-115 (4)(f), C.R.S. 1984, as amended); <br />3. As the applicant/operator, I do not have any mining/prospecting operations in this state <br />of Colorado currently in violation of the provisions of the Mined Land. Reclamation. Act <br />-(Section-34-32-3-a0~-C,-R.S--1984-as-amended)' ae"deteimined~through a Board finding. <br />4. I understand that etatementa in the application are being made under penalty of perjury <br />and that false etatementa made herein are punishable ae a Class 1 misdemeanor pursuant to <br />Section 16-8-503, C.R.S. 1984, ae amended. <br />This fozm has been approved by the Mixed Lead Raclama tion Hoard pursuant to section 34-3a- <br />11Z,C.R.B., oP the Mined Laced Reclamation Aet. Any alteration or modification oP tbis form eha1Z <br />result !n voiding any permit issued on the altered or modified form and subject the operator to <br />cease and desist orders and civil peaaltieo for operating rithout a permit pursuant to section 34- <br />3a-1x3, C.R.B. <br />Signed and dated this Z~ day of ~WY~~iI ZOC'Xp <br />~ If Corporation Attest (Corporate/County Seal) <br />..,.. ,r <br />5ignature:J ey: ~~v~' !"^^~' ~ ~,~~rLr~ <br />,/ Corporate Secretary or &quivalen <br />Title: //> f ! T t ~~~~~~-/N.4~~4GGe Town/City/County C1erR* - ~"' <br />- :+~ .. _ . <br />State of = --'''`-' ---^)- - - - _- <br />- ~_ _ . <br />CC i; <br />County of ~e'l~PKSQ~ ) ; •_ ~~ _ <br />P n <br />The foregoing instrument was acknowledged before a this ~ day Iof ~~ [ / ~I~___, `~/, <br />by' 1 ~ _s r ~ ae -of ~~I i u.h.X o 1V OLI~hILr.. ~? . <br />-~ Fre(~ J. er iCe ~P~esid ~ 3Q~~her-Trj hQg~~ <br />E = ~ /) ~ ~~ ~it,r <br />~~~UEReq •'- - -. ,: otary Public <br />O ~QT A R yC~m~'-~ ~ ~u~.+ i Ny Commission axpirea: <br />_,. <br />. <br /> t:;, <br /> <br />`p <br />l ~ • <br />^ - `• <br />Y <br />~I•tiYti 'J..~C`•~ <br />