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- 6 - <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. All necessary approvals from local government have been applied for (Section 34-32.5-110(1)(a)(viii). <br />2. To the best 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 200 feet of the proposed affected area have been identified in this application (Section 34-32.5- <br />115(4)(e), C.RS.). (NOTE: For 110 operations, the affected area includes all lands delineated by the permit boundary.) <br />3. No raining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-115(4)(f), C.R.S.). <br />4. As the applicant/operator, I do not have any mining/prospecting operations in the State of Colorado currently in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S.). <br />5. I understand that statements in the application are being made under penalty of perjury and that false statements made herein <br />are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S 1984. <br />Signed and dated this a% day of �2 ems/ , <br />Anthony A. Blasi <br />Applicant/Operator <br />Title: President: <br />State of Colorado <br />Count of guerfano j ss. <br />Y <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this �- day of 1 A , o�, by <br />r 1r� fz ! as py'P5, sV�7- ofrfF B 11g5nG £Rr+-kmewt <br />M qAJAA <br />Notary Pub is a / <br />My Commission expires: L)=I <br />SIGNATURES MUST BE IN BLUE INK <br />M:\MIN\SHAREIVSFORMS\2821CQ10.APP 10/15/01 <br />