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RECEIVED <br />-5- <br />Certification: <br />MAY 0 7 2003 <br />Division ~f Minerals and Geology <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 />I. This mitring operation will not adversely affect the stability of any significant, valuable and permanent man-made structure(s) located <br />within two hundred (200) fee[ of the affected lands. (However, where there is an agreement between the applicant/operator and the persons <br />having an interest in the swcnue that damage to the structure is to be compensated for by the applicandoperator (Section 834-32-115(4)(d), <br />C.R.S. 1984, as amended), then mining may occur within 200 fee[. Proof of an agreement must be subtnitted to the Office prior to the decision <br />date.) <br />2. No mining operation will be located on lands where such operations aze prohibited by law (Section 34-32-115(4)(f), C.R.S. 1984, <br />as atnended); <br />3. As the applicant/opera[or, I do not have anymining/prospecting operaflons in this state of Colorado currendy in violation of the <br />provisions of the Mined Land Reclamation Act (SectiOon 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 />S ~'^ 4~ <br />Signed and dated this ~ day of ~~ O '~ , <br />~;,...~ sl~~ G~« ~a~ m.~~,:~ <br />Applican perator or Company Name <br />Signed: ~ K ~ -. <br />Title: 1`ac•-lw,--. ~a'~ t ~ t'-`o ~.a3 pr <br />If Corporation Attest (Seal) <br />Signed: - <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of l_.lS-e[WtCzClu 1 <br />C' I'~ ) ss. <br />County ofL~' ` ~ 41~'ri- ) <br />The foregoing instrnument was acknowledged before me thisr .SCE- day of ~~ ~~r , r~i`)n3 <br />by~GLSrG f er"in° as t27~~-.~er. ~l.~G~~pae~ of ~txn~~,S~ae ~zclr,~ ~oc~, <br />Y <br />BEVERLY <br />ROLMER <br />~~~o ~_ <br />NotaryNotary Pu <br />My Commission expires: .~-/K '0~ <br />SIGNATURES MUST BE IN BLUE INK <br />M:4MINtBDCV~IINFORMS@823HR12.APP (10/15/2001) <br />