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<br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation <br />4scribed 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 of _A- Q ;tz_a <br />?Abplicant/Cperator If Corporation Attest (Seal) <br />Signed: <br />Signed: <br />Corporate Secretary or Equivalent <br />Title: Town/City/County Clerk <br />State of <br />!I ) ss <br />County of CAu/?i ? <br />The foregoing instrument was acknowledged before me this ' day of <br />by coft / ?! .lOhn O /I as 222//-L of _CL )9 1MY46 6A_ 1aM . <br />Notarv Public <br />My Commission expires: <br />0FdmcLwpf <br />41" <br /> <br />-a aoa d <br />