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5 <br />Certlficatloa: <br />As an authorized representative of the applica~ I hereby certify that the operation described has met the minimum requireaxnts of the following <br />terms and conditions: <br />1. This mining operation will not adversely affect the stabtlity of any significant, valuable and permanent man-made structure(s) <br />located within two hundred (200) fcet of the affected ]ands. (However, where there is an agreement between the applicanUoperamrnnd <br />the persons having an interest in the stmcture that damage to the sttuclure is to be compensated for by the applicaaUopemtor <br />(Section 83432-115(4)(d), C.R.S. 1984, as amended), thenminittg tmy ocem within 200 feet. Proof of an agreement must be submitted <br />to the Office prior to the decision date.} <br />2. No mining operationwillbelocatedonlandswhercstwhopetatioasareprolubitedbylaw(Section3432-115(4xE),C1LS.1984, <br />as amended); <br />3. As the applicanUopetator, I do not have any tnining/prospecting operations in this state of Colorado currently in violation of the <br />provisions of the Mined Land Reclamation Act (Secti0on 3432-120, C.R.S. 1984, as amended) as determined through a Board fording. <br />4. I tmderstand that statements in the application are being made under penalty ofperjury anti that false statements made herein are <br />punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS 1984, as amended. <br />Tb/s jot9n has been approved by the Mined Land Ree/amaHon Boardparsaant to seet/an 3d-32-112,CRS, ajthe Miaedland Reclamation <br />Act Any a/teiadan or modifrcation ojtbis jorm shall resuk /n voidtng any perm!! Issued an the akered or modifttd jorm and subject fbe <br />operator to cease and desist orders and etvllpeaabYes jot operatbtg witboru a permp pursuant to section 3d-32-123, GRS <br />Signed and dated this 10th day of August 2004 <br />Cotter Corporation <br />Applicandpperator or Company Name <br />Title: <br />If CorparationAt[est (Seal) ~ . <br />~ ~,/, ~. „ <br />Signed: ~~.!~!f 1 ~~ e~` <br />A~ti'1 Corporate Secretary m Equivalent <br />TowdCity/County Clerk <br />State of C~~~%~'~"~~ <br />ss. <br />County of <br />The foregoing incfrnmrat was acknowledged before n]C this ~~ day of ~ ~ <br />by ,~ ~/( ~ .I.LPl/fD as ~YD[' ~ ~ ~Lt of ~~.//LC'~7 ~Q~~/(-CL~Cl72[ <br />o Public <br />My <br />M:VdINU3DCiMII~ORbLS12823}IR12.APP (05260004) <br />31GNATURES MUST BE IN BLUE <br />TARJ- <br />~G <br />