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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(1)(a)(VIII). <br /> 2. To the best of my knowledge,all significant,valuable and permanent man-made structures)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 34-32.5-1 15(4)(fl. <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 by 1he Mined Land Reclamation Board pursuant to section 34-32.5-110,C.R.S.,of the Colorado Land <br /> Reclamation Act for the E.rtraetion of Construction Alaterials. Ati tv alteration or modification of thisform shall result in voiding anv <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, C.R.S. <br /> ,�t v- <br /> Signed and dated this 12 day of <br /> c- c 0—L �-J e, Colorado It Corporation Attest(Seal) <br /> Ap icant'Operator <br /> Signed: / ,;� —. — ✓z �� -1 Signed <br /> Corporate Secretary or Equivalent <br /> Title: l`� ' `� Toww q'County Clerk <br /> State of Colorado <br /> ss. <br /> County of Logan ) <br /> The foregoing instrument was acknowledged before me this 12t-h day of Alaril 2017 <br /> 6yy <br /> t, Donald J. s�a1'n , as City Mangey and <br /> Debra I,�m Par as City Clerk of the City of Sterling.. <br /> Colorado. <br /> _ ff , <br /> 'rotary Publ; <br /> My Commission expires: <br /> SIGNATI,RES MUST BE I1 BL.I.E INK JOSELYN A.WELSH <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 19874216736 <br /> MY COMMISSION EXPIRES OCTOBER 19,2019 <br />