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RECEI\OE® <br />RECEIl~~® APR 18 7006 <br />~{ 22~ -'- <br />J VN Division of iViinerals and Geology <br />Certification: <br />pivision of Minatals and Geolag <br />As an authorized representative ofthe applicant, I hereby certify thatthe operation described has met the minimum requirements ofthe <br />following terms and conditions: <br />1. All necessary approvals from local government have been applied for (Section 34-32.5-110(1)(a)(VII)). <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 £led, and located within 200 feet of the proposed affected azea have been identified in this application <br />(Section 34-32.5-115(4)(e), C.R.S.). (NOTE: For 110 operations, the affected azea includes all lands delineated by the permit <br />boundary.) <br />3. No mining operation will be Jocated on ]ands where such operations are prohibited by law (Section 34.32.5-115(4)(f), <br />C.R.S.). <br />4. As the applicanUoperatot, l do not have any miningiexploration op'etations il3the State of Colorado currently iri violation of ° -'"' <br />the provisions ofthe Colorado Land Reclamation Act forthe Extraction ofConstruction 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 />Thisjorm has been approved by theMined Land Reclamation Board pursuant to section 34-32.5-I10,C.RS., ojthe Colorado Land <br />Reclamation Actfor the Extraction ojConstrucdon Materials. Any alteration or modification ojthis jorm shall result in voiding any <br />permit issued arc the altered or modifred jorm and subject the operator to cease and desist orders and civil penalties jor operafing <br />without a permi! pursuant to section 34-32,5-123, C.RS <br />Signed and dated this ~~ day of <br />~~P ci ,1 ~~ ~/drrrS <br />Applicant/Operator <br />~.~~ t. ,...... .. ~: •. <br />~;.?Gap:: ~,,.: <br />If Corporation Attest (Sea ; ~ <br />Signed <br />r /' <br />' Title: 5~..-r~v+ P'~ \~e.e..'~ [>EJdhtS71. <br />(/7( <br />Signed: <br /> <br />Corporate Secretary of `~~ ~~'5'I I_•1 }~ ` '~ <br />Town/City/Coon., <br />- --- -State-of-~~/_cr~ t~-:_ )- ~~ -„ ~- - - -- --° - -' -°-° _ '- -- ~-- _ ~- ~ ~ -- - - - --- - - <br />ss. <br />County of ~L,,,,~ ) <br />' The foregoing instrument was ack~no~wledged before me this ~ 7 ~d/ay of ~?%r._~ o2nt~G+ , <br />SPRY P~@ <br />•.f /'' I <br />GAIL dVot Public <br />WEBB i~ <br />u~'%,~ • ,~ My Commission expires: ~-h - o-b~ ~ <br />' SIG)~(~•~p1~P~'iS~~~~~.UE INK <br />M:\min\shaze\vsforms\Constructionl l0 (Approved 05/11/2005) <br />t <br />