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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 requirements of the <br />following terms and conditions: <br />1. 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 <br />and the persons having an interest in the structure that damage to the structure is to be compensated for by the applicant/operator <br />(Section 834-32-115(4)(d), C.R.S. 1984, as amended), then mining may occur within 200 feet. Proof of an agreement must be <br />submitted to the Office prior to the decision date.) <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32-115(4)0, C.R.S. <br />1984, as amended); <br />3. 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 <br />finding. <br />4. 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 34-32-112,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 <br />and subject the operator to cease and desist orders and civil penalties for operating without a per . ursuant to section 34-32-123, <br />C.R.S. / ! <br />A49 &_ d f , L -I" William F. Ga cia, Chair, Weld County <br />Signed and dated this ay o <br />County Public Works Board of Commissioners <br />Weld If Corporation Attest (Corporate/County Seal) <br />Applipant/Operator Name <br />L <br />Signature: <br />Title: County Engineer <br />AttaGt_ <br />Clerk to the <br />By: <br />Deputy ClerV to the Bo <br />AUG 0 3 2009 <br />?o rCO ) ;; ` 'v <br />State of r <br />ss. <br />) <br />County of 6=2A& <br />, <br />The foregoing instrument was acknowledged before me this ' day of '4 <br />by Aa-el,(?l <br />kiNOTARY <br />Notary Public -"? <br />?`•. PUBLIG <br />My Commission <br />My Commissar Expres Sept 11 2009 <br />