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i Cer6fication• 6- As an authorized representative of the applicant, I hereby certify [hat [he opem[ion described has met the minimum requirements of the following terms and conditions: All necessary approvals from total government have been applied for (Section 34-32.5-I I I(1)(a)(IX)j; 2. This entire mining operation will not affect more than 30 acres; 3. This mining operation will not adversely affect thestabilityofanysignificant,valuableandpermanentman-made s[ructwe(s) located within two hundred (200} feet of the affected lands. (However, where there is an agreement between the applicantloperatorarad the persons having an interest in the structure [hat damage to the strncture is to be compensated for by the applicant/operator (Section 34-32.5-115(4)(e), C.R.S. 1984, as amended), [hen mining may occur within 200 feet. Proof of an agreement must be submitted to the Office prior to the decision date.) 4. 1Vo mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-115(4)(f), C.R.S. 1984, as amended); 3- As the app]icant/operator, I do not have any mining/exploration operations in this state of Colorado currently in violation of the provisions of the Colorado Land Reclatnation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S. 1984, as amended) as determined through a Board finding. 6. I understand that statements in the application are being made under penalty of perjury and that false statements made herein are punishable as a Class 1 misdemeanor pwsuant to Section 18-8-503, CRS. 1984, as amended. This form has been approved by the Mined Land Reclamation Baard pursuant to section 34-32.5-III,C.R.S., ofthe Colorado Land Rec[ama6a» Act for the Extraction ojConstrucdan Materials. Any alteration or modification of this jorm shall result in, voiding any permit issued on the altered or modified form and subject the operator to cease and desist orders and et~ut,~ penalties for operating without a permit pursuant to section 34-32.5-123, C.R.S. .; ~ /~ Signed and dated this G day Applicant/Operator ~/o V.E>/yi~.. B ~ y ~. ~ArinJ,i~1 Y If Corporation Attest By: 1~ ~ ~ p~. { v% - ^ ~ ~ 1 s - ~ ~ ~ / ~R i ~ r.. --- 1'' Cdrp~crl{ar~br Equivalent Title: /~'~- lv~~•own/ ty/County Clerk ~n1~T)'I~s )ss. _'- - -- - - - -- County of ) I The foregoing in-st~mment was acknawtedged before me [his ~ day of ~) w ~ ~- z by UfJIV~! L\f7~fE~til/~i as 2QT(-<`~fL(~NJ~r~C~of~~l~[~N~D/~IST2l,CC(t`D~~N My Commission expires: ~_ ~2a / ~U M:'anin'slure~~slbmu`d'oasmxfion I I 1 BF. IN BLLiE INK Zp-aL