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-8- <br />Certification. <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirement: of the <br />following terms and conditions: <br />I. This mining operation will not adversely affect the stability of any significant, valuable and permanent man-made structure(s) <br />located within two hundred (200) feet ofthe affected lands. (I lowever, where there is an agreement between the applicant operator <br />and the persons having an interest in the snRucture that damage to the structure is to he compensated for by the applicancopermor <br />(Section `34-32-11 5(4)(d), C.R.S. I984, as amended), then mining may occur within 200 feet. Proof ofan agreement must be <br />.submitted to the Office prior to the decision date.) <br />_'. No mining operation will he located on lands where such operations are prohibited by law (Section 34-32-115(4)(t), C.R.S. <br />IWS4, a5 amended); <br />3. AN the applicant/operator, I do not have any mining iprospecting operation, in this state of Colorado currently in violation of the <br />provisions of the Nlined Land Reclamation Act (Section 34-32-120, C.R.S. 1984, as amended) as determined through a Board <br />linding. <br />4. 1 understand that .statements in the application are being made under penalty of periury and that false statements made herein are <br />punishable as a Class I misdemeanor pursuant to Section 15-5-303, C.R.S. 1954, aS amended. <br />This %orm has been approved ht, the Wined Land Reclamation Board pursuant to section 34-32-112,(.R..S., of the :Wined Lund <br />Reclamation fet. Ant}' alteration or modification ol this form shall result in voiding, m{t• permit issued on the altered or modified loan <br />and subject the operator to cease and desist orders and civil penalties jar operating without a permit pursuant to section 34-32-123, <br />C. R.S. <br />Signed and dated this ?- 9,1n <br />day of /N Zoo <br />Denison Mines (USA) Corp. IfCorporation Attes (Corporate/County Seal) <br />vpplicanti(,Ipprator Name <br />Signatwe: <br />Bv: <br />Corpo at Secretary or Equivalent <br />Tiflr:..1 '.!' Town/Cit'Count ' Clerk <br />'-T? y cState of CoOrad (? ) <br />ss. <br />County of >r?i?lUe ? <br />tl'? <br />The foregoing instrument was acknowledged bet-tire me this day of ??? ZUU Cr <br />byt?h? 7f a, t1, of YJi5+N1 /J1 <br />CL,, fJ' / <br />y j/ do . ry Public <br />N1v Commission expires: <br />y??Z? ?ZV?