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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(Section 34-32.5-110(1XaXVIII). <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(4Xe),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)(0), <br /> C.R.S.). <br /> 4. As the applicant/operator,I 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 Act for the Earaction 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.KS. <br /> d-h <br /> Signed and dated this lgth day of 4 rkd , 0—.0( ,C <br /> Daniel L.Collins <br /> If Corporation Attest(Seal) <br /> Applicant/Operator <br /> Signed AL Cv Signed: <br /> Corporate Secretary or Et�enf <br /> Title: Managing Partner •......� LYME L ownlCity/County Clerk <br /> Commission aMM <br /> *nary Pubic-Ostrom <br /> County <br /> State of� 2-114(-A k F�Yr iso Empires <br /> A )� <br /> County Or IU.vl Cck ) <br /> The foregoing instrument was acknowledged before me this �� 7 day of Aril <br /> by 1/A4 - Gc!(,1.{�S as M/11Vb'l-I t N L j 4t2TN E1E' of///C.C)U:i N 5' -11012411-E140 LLG_ <br /> 111111- At <br /> My Commission expires: 0 y (-1/26/ <br /> SIGNATURES MUST BE IN BLUE INK <br />