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- 6 - <br />Certification: <br />As an authorized representative of the applicant, l 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.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by the permit boundary.) <br />3. No mining 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 day of ;?n p.2- <br />Anthony A. Blasi <br />Applicant/Operator <br />Title: President <br />State of Colorado ) <br />uerfano ) ss. <br />County of ) <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 , 91V by <br />Tn:�26 If, 11� c,` as _ <br />;d <br />�— ofr� �,6Y na t £�r�hrnaVt.,� <br />Arms..�v <br />o,. 40 <br />My Commission expires: f 19 &6� <br />SIGNATURES MUST BE IN BLUE INK <br />MAIv MHAREWSFORMS\2.821COMAPP 10/15101 <br />