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-7 - <br />Asan authorized re ressentative of the applicant, I hereby certify that the operation descnnImd has met the minimum requimnents ofthe <br />following terms and conditions: <br />I. AD necessary approvals from local government have been applied for (Section 34-32.5-1I0(lxa)(VilI). <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 fed of the proposed affected area have been identified in this application <br />(Section 34-325-1 l5(4xe), CILS.). (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 Whore such operations are prohibited by law (Section 34-325-115(4)(i), <br />C.R.S.). — --- --- -- <br />4. As the applicantloperator, I do not have any min€nglexploration operations in the State of Colorado currently in violation of <br />the provisions ofthe Colorado Land Reclamation Act for the Extraction ofConstruction Materials (Section 34-325-120, CILS.). <br />5. I understandtbat sWernents intheapplieation ambeingmade underpan dty ofperjwy andthat false slstementsmadeherem <br />are punishable as a Class 1 misdemeanor pursuant to Section 19-8-503, C.R.S.1984. <br />Thisfonnhas been approstd by A Alined Land Red= wkn Boardpursuant to section 34-325-II0,CJ U, ofthe Colamdo Land <br />Bedanaden Aedforthe Extradlon ofCons&uction Materials Any dAmmdon or nmdykadon ofthisfonnshoff r =U In vaidingany <br />pQndt issued on the altered or nmdb7ed form and subject the operador to corse and desist orders and dvil penddiesfor olwming <br />without apauR pursuant to sedion 34-325-123, GR & <br />Signed and dated this _ i r .4 day of`y ' L ' <br />10L6J <br />411ets1 iht 1 rI &vim <br />Appli Operator <br />Signed: n �a !& <br />Title: ZZ2or <br />7 3 <br />State of <br />If Corporation Attest (Seal) <br />Signed. �*€C,_ L L4•r ++! .., ..` <br />it3�County Clerk () ! r 1 <br />) ss. <br />County of -04,41111t# In � <br />The foregoing instrument was acknowledged before, me this % day of &Ii hzL <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY 1019954016068 <br />MY COMMISSION EXPIRES 12146/201 E <br />Notary Public - <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />