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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 34-32.5-1 10(1)(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 34-32.5-1 15(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)(f), <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. I 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 Board pursuant to section 34-32.S-110,C.R.S,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 ( I �� day of J ZC) <br /> a (o r (40 S C(V.-& (—o'w-P If Corporation Attest(Seal) <br /> Applicant/Operator <br /> Signed: dq`"r' Signed: <br /> Corporate Secretary or Equivalent <br /> Title: C�i e S �'hq Kc i i S�'i c-,e r Town/City/County Clerk <br /> State of PdD r4w(c ) <br /> )ss. <br /> County of �-,�%r ) '" <br /> The foregoing instrument was acknowledgedbefore me this � ( � day of J ULA `Q' <br /> by (�0-�Z(� A ` 1�7 -1-rSfly\ as L k.a v i;(-V of (�6 ro dodo Sa-ck LO�,QrKry U.L <br /> I <br /> DANIEL MILLS Nota ublic <br /> Notary Public <br /> State of Colorado My Commission expires: ff 2622- <br /> Notary 10*20184045904 <br /> My Commission Expires 1 1 29 2022 <br /> SIGNATURES MUST BE IN BLUE INK <br />