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-7- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the following <br />terms and conditions: <br />All necessary approvals from local government have been applied for (Rule 1.6.2(1) and (2)); <br />2. This entire mining operation will not extract more than 70,000 tons of mineral, overburden,, or combination thereof in any <br />calendar year (defined in Rule 1.1(24)); <br />3. 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 of the affected lands. (However, where there is an agreement between the applicant/operator and <br />the persons having an interest in the structure that damage to the structure is to be compensated for by the applicant/operator <br />(Section 34-32-115(4)(d), C.R.S. 1984, as amended), then mining may occur within 200 feet. Proof of an agreement must be submitted to <br />the Office prior to the decision date.) <br />4. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32-115(4)(f), C.R.S. <br />1984, as amended); <br />5. As the applicant/operator, I donot have any mining/prospecting operations in this state of Colorado currently in violation of the <br />provisions of the Mined Land Reclamation Act (Section 34-32-120, C.R.S. 1984, as amended) as determined through a Board findirig. <br />6. I understand that statements in the application are being made under penalty of perjury and that false statements made herein are <br />punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984, as amended. <br />This form leas been approved by the Mined Land Reclamation Board pursuant to section 34-32-IIO,C.R.S., of the Mined Land <br />Reclamation Act Any alteration or modifcation of this form shall result in voiding any permit issued on the altered or modified form and <br />subject the operator to 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 /V ~l~Vl 2~~ <br />~~~r~h, ; l~ 11'1 ~~ ~IT-g~-=J CD,f.~ <br />~• <br />~~~~`~ Ap~l~~~tfbperator .-r <br />,\r ~, ; , <br />*` <br />~- ~~•, <br />.,. ~ J • ., ~ ~ ~ F <br />,~c.. <br />^,. ' ' ~ : t <br />~~ ~ t~ r / <br />';'J' -Title: `~ /'/ i /.%1/ <br />~`'' c-'tii U~~ <br />State of <br />ss. <br />County of ~ ~/P ~- ) <br />If Corporation Attest <br />Signed: <br />or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this ~ ~ ~~ day of , <br />by Y~'lr ~I~ ~~.-. ~f/(: as ~ ~~ /~~~r1tYllil of ~..5 .~ , <br />%~J,"(,:-~ !;/ `~~~^` NOTA PUBLIC <br />`~ , <br />` My Commission expires: ~ ~/ / <br />SIGNATURES MUST BE IN BLUE INK <br /><~ <br />~~ ' ,t- <br />• ~ ~ , <br />%j, .:. <br />r'~ <br />