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-8- <br />Certification • <br />As an auttwriaed 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 applicant/operator and the persons <br />having an interest in the structure that damage to the structure is to be compensated for by the applicantioperator (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)(f), C.R.S. 1984, as <br />amended); <br />3. As the applicant/operator, I do not have any rrining/prospecting operations in this state of Colorado currently in violation ofthe provisions <br />of the Mined Land Reclamation Act (Section 34-32-120, C.R.S. 1984, as amended) as determined through a Board fording. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statements made herein are punishable <br />as a Class 1 misderneanor pursuant to Section 18-8-503, C.R.S. 1984, as amended. <br />This form has been approved by the Mitred Land Reclamation Board pursuant to section 34-32-112,C &&, of the 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.& <br />Signed and dated this I S day of ?T <br />American Soda, L.L.P. <br />If Corporation Attest (Corporate/County Sea]) <br />Applicant/Operator Name <br />Signature: y: <br />Title. V LA,./- MArJA t<?- <br />State ofCQC-,4,b 0_1 <br />County of -6t`'-) <br />TowmiCity/County Clerk <br />) ss. <br />"11e foregoing instrument was acknim igdged before aw tht:1'? <br />by - s ..-. &n1Y W of A- vnt!Lwn.-'?& \ <br />RHONDA L. <br />HARRIS <br />My Commission Expires 04105108 <br />Corporate Secretary or Equivalent <br /> <br />tiotary lPublic <br />My Commission expims:..-...?.? <br />f