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7 - <br />Certification: <br />As an authorized representative of the applicant, l 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(I)(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 filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(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(4)(f), <br />C.R.S.). <br />4. As the applicant/operator, I do not have any mining/exploration operations in the State ofColorado curmntly 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 ofpit my 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 Boardpur oomf to section 34-31.5-110,CR.S, of the Colorado Land <br />Reelamation Acifor the Extraction ofConsouction Materials. Any alteration or modification ofthuform.shallrosult in voiding any <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and eivil penalties for operating <br />without a permit pursuant to section 34-31.5-113, CIL& <br />Signed <br />\and <br />dated this �a% day of Q / <br />V J /V' l r/�l pn" If Corporation Attest(Seal) <br />AppEcant/Operator <br />Signed: "Du/`C /r"C/✓1 Signed: <br />Title: <br />j1 Corporate Secretary or Equivalent <br />Q W ' —' Town/City/Cowry, Clerk <br />State of e?5(ni44nCoumyof <br />) <br />r1 L J 55. <br />t7 OL <br />The fore mug instrument/was acknowledged before me thhiis� �, . day of r XOR <br />by ,( ,SA%m idT as (JGA%)�_ of <br />GINNI OLACHEA Nomry Public <br />Notary c 04 �C/ zoiri( <br />Satee Color of Colorado My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />