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-6- <br /> Certification: <br /> an authorized representative of the applicant, I hereby certify that the operation <br /> scribed has met the minimum requirements of the following terms and conditions. <br /> 1. This mining operation will not adversely affect the stability of any significant, <br /> valuable and permanent man-made structure(s) located within two hundred (200) feet of <br /> the affected lands . (However, where there is an agreement between the <br /> applicant/operator and the persons having an interest in the structure that damage to <br /> the structure is to be compensated for by the applicant/operator (Section <br /> 34-32-115 (4) (d) , C.R.S. 1984, as amended) , then mining may occur within 200 feet. <br /> Proof of an agreement must be submitted to the Office prior to the decision date.) <br /> 2. No mining operation will be located on lands where such operations are prohibited <br /> by law (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 <br /> this state of Colorado currently in violation of the provisions of the Mined Land <br /> Reclamation Act (Section 34-32-120, C.R.S. 1984, as amended) as determined through a <br /> Board finding. <br /> 4. I understand that statements in the application are being made under penalty of <br /> perjury and that false statements made herein are punishable as a Class 1 misdemeanor <br /> pursuant to Section 18-8-503, C.R.S 1984, as amended. <br /> Signed and dated this day of4Iq <br /> Q <br /> • Ap#lrerator e-o,pnwy If Corporation Attest (Seal) <br /> Signed: Signed: l�� <br /> �1 pD Corporates ecretary or EgLuva'lent <br /> Title: �ic[ !R<,s.uf r f �1F.Va4t 44;#,✓m&e Town/City/County Cler c <br /> State of <br /> as <br /> County of <br /> The foregoing instrument--was <br /> '' acknowledged before me this d day of <br /> l 1c rg <br /> by j)Y! `�D�. `bS as Vi����naf <br /> Q . <br /> Notary Public <br /> My Commission expires: �/�2�� <br /> WFdmuwpf <br /> /14/94) <br />