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-7- <br /> Certification: <br /> As an authorized representative of the applicant.1 hereby certify that the operation described has met the minimum requirements of the <br /> following terms and conditions: <br /> l. 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 <br /> (Section 34-32.5-115(4)(e),C.R.S.). (NOTE: For l 10 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 34-32.5-1 15(4)(f), <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. 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 form has been approved bj,the Mined Land Reclamation Board pursuant to section 34-32.5-110,C.R.S.,of the Colorado Land <br /> Reclamation Act for the Extraction of Construction Materials. Anj•alteration or modification of this form shall result in voiding anj, <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, CjRR.S�t. <br /> Signed and dated this Fk�ST day of 1��V 5� 20` <br /> ArhO` LJO A xt!/iUp , Un(I If Corporation Attest(Seal) <br /> Annlica p rator <br /> t <br /> Signed. Signed: <br /> Corporate Secretary or Equivalent <br /> Title: Vice President Town/City/Count) Clerk <br /> State of t (-AG► G f D ) <br /> ss. <br /> County of_CA ka S ) y <br /> The foregoing instrument was acknowledged before me this St day of nUG l lc` <br /> ,byV.\CK bma(\ as if `c,C ��i �C�CfL� of(]C(\ackc' CIIS :0A C da <br /> I_LC <br /> MONICA POOLE �`1\�G`fV C C- <br /> NOTARY PUBLIC Notary Public <br /> STATE OF COLORADO <br /> My Commission expires:a-� �--� <br /> NOTARY ID 20064049340 T�- <br /> Y COMMISSION EXPIRES FEBRUARY 27,2018 <br /> SIGNATURES MUST BE IN BLUE INK <br />