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RECEIVED <br />AUG 0 5 2004 <br />CertlticaNon: <br />Oivisian of Minerals end GeoloBY <br />As an authorized representative ofthe applicant, I hereby certify that the operation described has met the m;n;nn,m requirements of the following <br />terms and conditions: <br />1. This mining operation will not adversely affect the stability of any significant, valuable and perniaaentman-made stmcture(s) <br />located within two hundred (200) fcet of the affected hinds. (However, where there is m agreement between die applicant/opemtorond <br />the persons having an interest in the structure that damage ro the structure is ro be compensated for by the applicanVoperaror <br />(Section 834-32-1 l5(4)(d), C.R.S. 1984, as amended), thenmining tiny occur within 200 feet. Proof ofan agreement Est be submiaed <br />ro the Office prior to the decision date.) <br />2. No mining operation will be located on lands where suchaperations are prelubited by law (Section 34-32-I15(4xf), C.R.S. 1984, <br />as untended); <br />3. As the applicant/operaror, I donothave any miniag/prospecting operations in this state of Colorado currently in violation ofthe <br />provisions of the Mined Land Reclamation Act (SectiOon34-32-120, 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 ofperjury and that false state tents made herein are <br />punishable as a CLrss 1 misdemeanor pursuant ro Section 18-8-503, C.R.S 1984, as amended. <br />This form has be¢n approved by the Mined Land Reclamation Board pursuant to section 34-32-112,GRS, ojtheMtned Land Reclamation <br />Act Any operation or modifreadon ojthis farm shall result In voiding any permit issued on tbt altered or modified form and subject the <br />operator to cease and desist orders and cPoll penalties jar operating wttbaut a permit pursuant to section 34-32-123, GRS <br />Signed and dated this 5th <br />Cotter Corporation <br />Applicant/ or Comp; <br />Signed: < <br />Titre: Executive Vi e <br />day of August 2004 <br />If Corporation Attest (Seal) ; ~ - ^' ' - - <br />/ - ..f ~~. <br />Signed: ~ + v4 ~ <br />~ _ <br />Corporate,(Seeretary or Eglttvalent <br />TowdCity/County Clerk <br />State of (~.~L~a~ ) <br />as. <br />County of (t/Yjllil~ ~ ) ~ <br />The foregoing instrument was acknowledged before me this .~J ~ day of <br />by .- ~ <br />.~~v i~ <br />- - Q "-/~' <br />__ ~ ~ -__ <br />%~ .. <br />~" ~ SIGNATURES MUST BE IN BLUE ]?iK <br />M:VviG~IV3fSC1MIIQFOR1vLSl2$23HRI2.APP (052fi12004) <br />My Commission expires: ~~ ~.~-~~ <br />