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-7 - <br />Certification: <br />As an authorized representativeof the applicant, l hereby certify that the operation described has met the minimum requirements ofthe <br />following terms and conditions: <br />I. All necessary approvals from local government have been applied for (Section 34-32.5-1 10(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 tiled, 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: I -or 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 34-32.5-11 5(4)(t). <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 f'orthe Extraction ofConstruction Materials (Section 34-32.5-120. C.R.S.). <br />5. I understand that statements in the application are being made under penalty of perjur) and that false statements made herein <br />are punishable as a Class I misdemeanor pursuant to Section 18-8-503. C.R.S. 1984. <br />This form has been approved by the Mined Land Reclamation Boardpursuani to section 34 32.5-110,C.R.S., ofthe Colorado Land <br />Reclamation Act for the Ertraction ofConstruction Materials Any alteration or modification of this formshal! restelt in voirlinR ani, <br />permit issued on the altered or nodi ied 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. <br />Signed and dated this iaday of tc) Gyt-c�`C <br />C"3A lc F� � (.G <br />Applicant/Operator <br />Signed: <br />Title: GM <br />State of O fGt ) <br />Count) of ) <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />To\vnlCitylCounty Clerk <br />The foregoing instrument was acknowledged before me this 1— _or day of �7er <br />b} Lzm0fos as 19M of Ea + 1 �a�Fl� t clrrs, L.±.t• <br />C_4� — V <br />Notary Pub is <br />My Commission expires: 6 .a - 19 <br />SIGNATURES MIDST BE IN BLUE INK LYN MCCALL <br />NOTARY PUBLIC <br />STATE Of COLORADO <br />NOTARY ID 24074016727 <br />MY COMMISSION EXPIRES MAY 02.2019 <br />