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:ertification: <br />- 8 - <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 />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 permit pursuant to section 34 -32 -123, <br />C.R.S. <br />igned and dated this <br />Cotter Corporation (N.S.L.) <br />Signature: <br />Title: <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)(f), 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, except that the Mined Land Reclamation Board issued "Findings of Fact, <br />Conclusions of Law, and Order ", Cotter Corporation, File No. M- 1977 -300, [con't. below] <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 />Applicant/Operator Name <br />Amo- Quin <br />President <br />day of <br />State of G' <br />ss. <br />County of S - <br />'/ / <br />The foregoing instrument was acknowledged before me this <br />4 -/�v4 , e7seder ( ( / ec (��pi%i ,r -�/�!- CN L ) <br />b /Ad ✓ as of <br />JENNIFER R. LEAR <br />COMN. 01$07112 <br />WNW N UIIC *CALIFORNIA <br />SAN 0E00 COUNTY <br />Cow. .17, 2012 <br />. <br />If Corporation Attest (Corporate /County Seal) <br />°"), 1 <br />By: t.3nCAt ti_G <br />Corporate or Equivalent <br />Town/City/County Clerk <br />day of <br />Notary Public <br />My Commission expires: -S4 / 7 e /0 4 - <br />MV- 2010 -018, served August 11, 2010, and "Findings of Fact, Conclusion of Law, and <br />Order ", Cotter Corporation, File No. M -1977 -300, MV- 2010 -030, served December 9, 2010, <br />both of which are being appealed by Cotter Corporation (N.S.L.). <br />