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-7- <br />Certification: <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 />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 Boardpursuant 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 apd civil penalties for operating without a permit pursuant to section 34 -32 -123, C.R.S. <br />Signed and dated this day of <br />Providence Mining, LLC <br />Applicant /Operator <br />Signed: <br />Title: Manager <br />State of <br />ss. <br />County of .mil �/ ) <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City /County Clerk <br />The foregoing instrument as acknowledged before me this 4 day of 11 G� 13 <br />by s`�%.��\ 11 T Dom_ asA&f- &O_rz�ag, d_a.A k of 7dnQ: A -,A L�11n�di <br />0 4�Q J ¢� <br />NOTARY PUB <br />/% •'pTA;4•ti � My Commission expires: <br />S N RES M>T B IN BLUE INK <br />IPA G •� Q <br />y�� ke C� 0`0 Pe4 <br />