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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 />1. 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 do not 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 />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32-110,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 34-32-123, C.R.S. <br />Signed and dated this day of MaAA <br />RA?,1;h S I?C'nn <br />vV <br />?.+ Appp,canr/(Jperator <br />4 <br />?i <br />M s <br />% <br />Si$6nnp <br />" 1 f <br />State of CJ ra n ) <br />ss. <br />County of l c'N 11?e? ) <br />If Corporation Attest (Seal) <br />Signed: <br />I/V <br />Corporate S cretary or Equivalent <br />Town/City/County Clerk <br />-YY? <br />The foregoing instrument was acknowledged before me this day of A o, 2,00q <br />by ?h 0 i ?D V (rV ? as M i Yjl M of _D sA- ov <br />fry:=.??t.'•'?,: ?_?; - <br />f ?•; C??? f// .C NO Y PUBLIC <br />;. - <br />-A <br />My Commission expires: '')Z ? 2v <br />SIGNATURES MUST BE IN BLUE INK <br />`T. / U_'