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RECFIVED
<br /> DEC 0 6 2016
<br /> R
<br /> CertCertificationWATER STATE ENGINEERESOURCES
<br /> COLD
<br /> As an authorized representa!lxle(if the applicant,I hereby cenify that the operation described has met the minimum
<br /> following terms and conditions: ri-ii-nu n requirements of the
<br /> I All necessary approvals front local govemment have been applied for(Section 34-32.5-11 0(1)Ca)(Vlll)
<br /> 2, To the best of my k-nowledge, all significant, valuable and permanent than-made structure(s)in existence at the Time this
<br /> application is filed, and located within '00 feet of the proposed affected area have been identified in tits application
<br /> (Section 34-32 5-11 5(4)(e),C,R.S,), (NO F: For I 10 operations,the affected area includes all lands delineated by the permit
<br /> boundary,)
<br /> 3 No mining operation will be located cn-, lands where such operations are prohibited by law (Section 34-32�5-1 1
<br /> C R.S.)., I
<br /> 4, As the apphcarMoperator.I do not have any rnim I rig,,exploration operations in the State of Colorado currently it,vio1311011 of
<br /> the prop r,,ions of'fie Colorado Land Reclamation Act for the Extraction of Construction.MRtel"als(Section 14-325-I-10,C.RS,).
<br /> 5, 1 undeistand drat statements the application are being made under penalty ofstatementsury and that false statements 111ade Felelll
<br /> are pumil,,nible as a class I misdemeanor pjjrjuanj jo Section18-8-503,CRS.' 1984,
<br /> This fi)rm has beenRer�lrrnratiorz Board pur-mantiosection 34-32.5-110,(',R.S,,of the Land
<br /> Rechnnation Actlitr the h'xtrai tilm of Atq altcrafiim or modification of this farm shall res ,hit;jr4)itjijj,,ajz),
<br /> P,
<br /> P"I'Mit issaed on the aftered or modifted,fornt rind subject the operator to cease and desist orders and cirilpenalli,-s /,)I.o1wrall.lig
<br /> without a permit pi4r.k,all,to section 34-32.5-123, C.R.S.
<br /> Signed and da!ed this
<br /> day of
<br /> IfCOrporation Attest(Se;41 i
<br /> Signed,
<br /> Signe&
<br /> Corporate Secretary or Fquiv.,'C:
<br /> Fown.,Clt� COLL111V Glens
<br /> k
<br /> State of l4 U s 46-
<br /> Sa
<br /> County
<br /> The foregoing instrurnent was acknowledged before me this
<br /> by as 1,.IL, -, r,, t
<br /> of (I L&i4 i-e-all If i
<br /> My Commission expires 07TAR
<br /> SIGNATURES MUST lit:IN BLUE INK
<br /> PUBLIC
<br /> 'X*01 M/131013
<br />
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