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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 /> I. All necessary approvals from local government have been applied for(Section 34-32.5-110(1)(a)(V1I1). <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 34-32.5-1 15(4xe),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 34-32.5-115(4xf), <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 the Mined Land Reclamation Boardpursuant to section 34-3Z.5-110,C.RS.,of the Colorado Land <br /> Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of thisform shall result in voiding any <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 /> Signed and dated this ��" day of � <br /> PY <br /> Colorado Rose Red, Inc. If Corporation Attest(Seal) `j7 <br /> Applicant/Op for/ � <br /> , , <br /> Signed: Signedef � <br /> Corporate Secretary or Equivalent <br /> Title:Rresident Town/City/County Clerk <br /> State of Colorado ) <br /> ss, <br /> County of L 4awmorr2.. <br /> The foregoing instrument was acknowledged before me this FK day of D'd-c4pol <br /> i-wnk- <br /> by Caleb Liesveid as President of Colorado Rose Red, Inc. <br /> CZ�a� <br /> Notary Public <br /> STEMAN L OSMAN <br /> (VOTARY PUBLIC My Commission expires: <br /> STATE OF COLORADO <br /> NOTARY ID 199MI6709 <br /> MY COMMON EM SOCT9BB30,2W IGNATURES MUST BE IN BLUE INK <br />