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-7- <br />ertifieotion: <br />As un authorised representaticc of the applicant. I hereby cenil j that the operation described has met the minimum requirements ofthe <br />following terms and conditions: <br />1. All ntwssart approi.als fn)m local govemment hacc been applied liar (Section 34- 32.5 -1 l0(I )taHVIll ). <br />2. 1'o the hest of my knowledge, all significant, valuable and permanent man -made structure(s) in existence at the time this <br />application is filed, and located within 2W list of the proposed at %cited area have been identified in this application <br />(SLetion 34- 32.5- 115(4He). C.R.S.). (;,,TOFF.: For 110 operations. the aticcted area includes all lands delineated hs the petmit <br />lwun(lan . ) <br />3. No mining operation will be located on lands Kherc such operations are prohibited h} la% (Section <br />C.R.S. ). <br />4. As the applicanvoperatur. I do not hat a an} mining'ceploration operations in the State of C clorado cun•rntly in c iolation cif <br />the prov isior cif the Colorado land Reclamation Act fur the Extraction ofC'onstruction Materials (Section 34- 32.5 -120. C.R.S. ). <br />S. i understand that statements in the application are being made underpenalt) of•perjut) and that false statement,,, made herein <br />are punishable as a Class 1 misdemeanor pursuant to Stt;tion 18 -8 -503. C.R.S. 1984. <br />This form has been approved by the Mlned Land Reclamation Board pursuant to section 34- 31.5 -11 U.GRS., of the Colorado Land <br />Rec lumation Act forthe Extraction of Construction MateriaLc..4n)• alteration or modification of thisformvitall m.-uh In voiding amv <br />permit Issued on the altered or modifled form and subject the operator to cease and desist orders and civil penalties for operating <br />without a perml( pursuant to section 34 -3Z5 -123. C.R.S. <br />Signed and dated this _ ✓{ , � f Y <br />,.r <br />IL rE�iNS M' S T;< VC i /CN <br />, L.. L -Lj' [f Corporation Attest (Seal) <br />Applicant/Operator <br />Signed: _U �ctalv� ✓ � ��ti Signed: <br />4 Corporate Seerctaq or I;yui%alent <br />Title: ^ -I ,..Lt -et� l'ocvnlCityli'ounty ('fork <br />State of <br />ss. <br />County of <br />1 he tier ;going instrument was acknowledged belbre me this _ � � r day of <br />h} �l Gt .-tQ �( �o'l�� +ir)�� ae_(C"F r a' .2( / d i,t�l1 _lit_ i• i S (�f., ,� :•rs rl��,) <br />Notan Public - - - - - - - <br />M. % Commission c .xpire %: <br />SICNATI RFUS MUST OF IN BLUE INK <br />