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-~- <br />Certification: <br />As an authorized represenmtive of the applicant, l hereby certify that [he operation described has met the minimum requirements ofthe <br />following terms and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-I10(1)(a)(VIII). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made svuc[ure(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 [his 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 pennil <br />boundary.) <br />3. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-I15(4)(f), <br />C.R.S.). <br />4. As [he applicanUoperator, I do not have any mining/explorationoperotions in the State of Colorado currently in violation of <br />the provisions ofthe Colomdo Land Reclamation Act for the Exvaction of Construction Materials (Section 34-32.5-] 2Q, C.R.S.). <br />5. I understand that statements in [he 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 34-325-I1 QC.R.S., ojthe Colorado Land <br />ReclamationActjortheExtrac[ionojConslruetionMaterra/s. Artyaherabonormod~cationojthisjormshaRratiltinvoidingany <br />without a pe~mit pursutant~ section 34-32.5-113, C.R.S. the operator to cease and desist orders and civilc^~r!? o~ erMirrg <br />Signed and dated this __~_ day of ~u n3 C 2Od r ' ice. ~ ~ „ <br />~, ~. =~ <br />rC r e QC. ~Anl ~ ~~ ~ ~ If Corporation Attest CSeal}: ' .,^ ,, ~Yr" ^~ ~' <br />ApplicanUOperafor %i~~lrr,-r ~^'^~~ "}~, <br />Signed: !~. ~rw ~--- ~1~ ~ Signe / ~ ~~ ...s --~ ~f C .~ <br />.y/t / f~ Corporate Secretary or Equivalant <br />Title: <il~s ni~Y~:x/ t Town/City/County Clerk <br />State of '+._C/.b%Rt~n ) <br />) 55. <br />Connn'of__~EL i 9 ) <br />The foregoing instrument was acknowledged before me this ~ dac of a,~i.~-s <br />.AC~. by ~la-./t ~L~~S r,,..t L1ll\a.vv In~C,(l5 as ~r^rSiw{ervt- - .2 ~cc r~-4r v~y of <br />t <br />RY P ~ <br />~P,......~/~ <br />,?0% ~(/(1 Notary Public <br />.~ ~ S ~ Mc Commission expires: ~~ - Q ~ - Gfv <br />~~ ~ <br />:~ <br />BLUE INK <br />M:\min\shnrelvsforms\Constructionl 10 (Approved OS/1 <br />