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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)(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. <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 permit pursuant to section 34 -32 -123, <br />C.R.S. <br />Signed and dated this 2A day of — Tv ri e, , 2,0/Z. <br />Star Mine Operations, LLC <br />Applicant/Operator Name <br />Signature <br />O <br />Title: <br />State of &" 4,10 a <br />) ss. <br />County of We Al ►'re_/L ) <br />The foregoing instrument was acknowledged before me this <br />by (� W /Lt//i�f as <br />If Corporation Attest (Corporate /County Seal) <br />By: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />oZ / St <br />PA. CC)� /iiz <br />� j�NOTA/�y• `vv <br />�i'pUBLtC {o <br />FOF 001.0 <br />day of J01MC o /2 <br />Notary Public <br />expires: ew, 6-. "/ J-- <br />