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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(I)(a)(VIII). <br /> 2. To the best of my knowled;e,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,I do not have any minin_a"exploration operations in the State ofColorado 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. 1 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 farm has been approved by the Alined Land Reclamation Board pursuant to section 34-32.5-110,C.R.S.,of the Colorado Land <br /> Reclamation Actfor fire Ertraction of Construction Materials. Any alteration or modification of thisform shall result in voiding,any <br /> permit issued an the altered or modified form and subject Cite operator to cease and desist orders and civil penalties for operating, <br /> without a permit pursuant to section 34-3 2 5-123,C.R.S. <br /> Signed and dated this day of 0, , a <br /> L_L-C_ If Corporation Attest(Seal) <br /> Van Valkenburg Cattle Co., L <br /> Applicant/Operator <br /> Signed: Signed: <br /> William Van Valkenburg Corporate Secretary or Equivalent <br /> Title: Manager <br /> Town/City'County Clerk <br /> State of ft(_Z�, <br /> ss. <br /> County of �PtiC;� cSC�t l ) `- <br /> C �LLThe foregoing instrument was�ackn wledged before me this � day of_,_, <br /> by j s of <br /> L.GG <br /> STORMY R. FOLLE17 <br /> NOTARY PUBLIC otary Public <br /> STATE OF COLORADO <br /> NOTARY ID#20024021005 ly Commission expires: <br /> It My Commission Explrss Apol 23,2017 <br /> SIGNATURES MUST BE IN BLUE INK <br />