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Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation <br />described has met the minimum requirements of the following terms and conditions: <br />1. This mining operation will not adversely affect the stability of any <br />significant, valuable and permanent man -made structure (s) located within two hundred <br />(200) feet of the affected lands. (However, where there is an agreement between the <br />applicant /operator and the persons having an interest in the structure that damage <br />to the structure is to be compensated for by the applicant /operator (Section <br />834- 32- 115(4)(d), C.R.S. 1984, as amended), then mining may occur within 200 feet. <br />Proof of an agreement must be submitted to the Office prior to the decision date.) <br />2823F <br />(10/14/94) <br />• <br />-5- <br />2. No mining operation will be located on lands where such operations are <br />prohibited by law (Section 34- 32- 115(4)(f), C.R.S. 1984, as amended); <br />3. As the applicant /operator, I do not have any mining /prospecting operations in <br />this state of Colorado currently in violation of the provisions of the Mined Land <br />Reclamation Act (Section 34 -32 -120, C.R.S. 1984, as. amended) as determined through <br />a Board finding. <br />4. I understand that statements in the application are being made under penalty <br />of perjury and that false statements made herein are punishable as a Class 1 <br />misdemeanor pursuant to Section 18 -8 -503, C.R.S 1984, as amended. <br />Signed and dated this day of <br />Applicant /Operator If Corporation Attest (Seal) <br />By: By: <br />Corporate Secretary or Equivalent <br />Title: Town /City /County Clerk. <br />State of <br />) ss <br />County of <br />The foregoing instrument was acknowledged before me this day of <br />by as of <br />Notary Public <br />My Commission expires: <br />