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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 />1. All necessary approvals from local government have been applied for (Section 34-32.5-110(1)(a)(VII1). <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 <br />(Section 34-32.5-115(4)(e), C.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by the permit <br />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), <br />C.R.S.). <br />4. As the applicant/operator, 1 do not have any mining/exploration 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 />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-110,C.R.S., of the Colorado Land <br />Reclamation Actfor the Extraction of Construction Materials. Any alteration or modification of this form shall result in voiding any <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating <br />without a permit pursuant to section 34-32.5-123, C.R.S.�7 r� j <br />'Tit <br />Signed and dated this .Tl day of D tom+ V eF l(2- 2.0 l S- . <br />lef7uthiv LLi /rid AF1-t10Leto S <br />Applicant/ . - rator <br />If Corporation Attest (Seal) <br />Signed: ; " - Signed: <br />Title: %eP lAr/a1--) -e'er <br />State of OA) [l(} R,() ) <br />Ki‘ ) ss. <br />County of MOff- r ) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument�was acknowledged before me this L.� r day of OCZ)24:12..1 2D I:5 /� <br />, by Set [S'i f ft tU 1 O as �i ,' O -6-12, of )C � 0 LL . <br />BRANDY HIXSON <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID #20144036297 <br />My Commission Expires September 16, 2018 <br />ublic <br />My Commission expires: "71, (.l II 4 <br />SIGNATURES MUST BE IN BLUE INK <br />