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Certification: <br />-7- <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. Proofofan agreement must be submitted to <br />the Office prior to the decision date.) <br />4. No mining operation will be located on ]ands 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 finding. <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 />TJiis form has 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 modification 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-I23, C.R.S. <br />Signed and dated this 2~1~'' day of Mal /, t-(~/ <br />,~,f : , <br />= ~t <br />s~A}~hc} antlQ.perator - <br />~`~M1Q ~ 2„ <br />> '~ - <br />i, Slgri v ~~~ C,~~y~s <br />State of~'r~lt~ra~ ~ ) <br />ss. <br />County of~id.{''I~t'i1~ ) <br />[f Corporation Attest (Seal) <br />Signed: <br />0 orate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this ~" I ~ day of / V - /~.~ ~ w <br />1 ' > <br />by ~C. - ~_-- as 1/ ~ (~ 1~ I Yl 1 l1 d1 of ,¢ <br />Ct~Y <br />f_`~ c; `_ '4 NOT Y PUBLI <br />r. ,`,'. <br />~~ ~' My Commission expires: Z Z~ <br />SIGNATURES MUST BE IN BLUE INK <br />`',:~;;, ;: f~U I~ LAC <br />`~• .. <br />C~`~ <br />.. := <br />