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-8- <br />Certification: <br />As an authorised representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the following <br />terms and conditions: <br />1. This mining operation will not adversely affect the stability of any significant, valuable and permanent man-made structure(s) located <br />within two hundred (200) feet of the affected lands. (However, where there is an agreement between the applicantloperator and the persons <br />having an interest in the structure that damage to the structure is to be compensated for by the applicant operator (Section 834-32-115(4)(d), <br />C.R.S. 1984, as amended), then mining may occur within 200 feet. Proof of an agreement must be submitted to the Office prior to the <br />decision date.) <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32-115(4)(0, C.R.S. 1984, as <br />amended); <br />3. As the applicantloperator, :l do not have any mining/prospecting operations in this state of Colorado ctu.7ently in violation of the provisions <br />of the Mined Land Reclamation Act (Section 34-32-120, 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 statements made herein are punishable <br />as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984, as amended. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32-112,CR.S., ofthe Mined Land Reclamation Act. <br />Any alteration or modification of this form shall result in voiding any permit issued on the altered or modified form and subject the operator to <br />cease and desist orders and civil penalties for operating without a permit pursuant to section 34-32-123, C.R.S. <br />Signed and dated this "day of NOV'E??i Q /L 2 ?? <br />N U 4wo I LL If Corporation Attest (Corporate/County Seal) <br />Applicant/Operator Name <br />gy EwtSu" r-.C , tTs M Atq A 6F <br />Signature: By: ?j y L- (,,. SM l L-1{ 6 `I 1 (i-S M t GU- <br />/ Corporate Secretary or Equivalent <br />Title: <br />State of Cka-k--) <br />County of -APO-60e <br />TowalCity/County Clerk <br />) ss. <br />'T`he foregoing instntment was acknowledged before me this 1%tay Of ?(D?lQni?bee- W9 <br />byUlas._LuuaW -of.IYUVIC. <br />0oxt iuuuI///// <br />\\?? ???, ....... ?•F •?? tary Pttblie <br />OTARy 5 c 1-, .- <br />My Conunission expires:_._. <br />NJ' Puav 0 <br />/'///?/ ?OFt n tOVO `\\\`\