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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 <br />following 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 <br />any calendar year (defined in C.R.S. 34- 32- 110(2)(a)); <br />3. This mining operation will not adversely affect the stability of any significant, valuable and permanent man-made <br />structure(s) located within two hundred (200) feet of the affected lands. (However, where there is an agreement between the <br />applicantioperator and the persons having an interest in the structure that damage to the structure is to be compensated for by the <br />applicant/operator (Section 34- 32- 115(4)(d), C.R.S. 1984, as amended), then mining may occur within 200 feet. Proof of an <br />agreement must be submitted to 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), <br />C.R.S. 1984, as amended); <br />5. As the applicant/operator, I do not have any mining/prospecting operations in this state of Colorado currently in <br />violation of the provisions of the Mined Land Reclamation Act (Section 34 -32 -120, C.R.S. 1984, as amended) as determined <br />through a Board fording. <br />6. I understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein are 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- 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 <br />form and subject the operator to cease and desist orders and civil penalties for operating without a permit pursuant to section <br />34 -32 -123, CRS. <br />Signed and dated this <br />Applicant/Operator <br />By: <br />Title: <br />day of <br />State of ) <br />) ss. <br />County of <br />The foregoing instrument was acknowledged before me this <br />by <br />as <br />day of _ <br />of <br />SIGNATURES MUST BE IN BLUE INK <br />If Corporation Attest (Seal) <br />By: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />Notary Public <br />My Commission expires: <br />