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<br />- 6 - <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation <br />described has met the minimum requirements of the following terms and conditions: <br />1. All necessary approvals from local government have been applied for <br />(Section 34-32.5-110(1)(a)(viii). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made <br />structure(s) in existence at the time this application is filed, and located within 200 <br />feet of the proposed affected area have been identified in this application (Section 34- <br />32.5-115i4)ie), C.R.S.). (NOTE: For 110 operations, the affected area includes all lands <br />delineated by the permit boundary.) <br />3. No mining operation will be located on lands where such operations are prohibited by <br />law (Section 34-32.5-115(4)(f), C.R.S.). <br />4. As the applicant/operator, I do not have any mining/prospecting operations in the <br />State of Colorado currently in violation of the provisions of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, <br />C.R.S.). <br />5. 2 understand that statements in the application are being made under penalty of <br />perjury and that false statements made herein are punishable as a Class 1 misdemeanor <br />pursuant to Section 18-8-503, C.R.S 1984. <br />Signed and dated this ? ~ day of /9 q~. CO <br />A}, <br />If Corporation Attest (Seal) <br />igned: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of Colorado <br />ss <br />County of Phillips ) <br />The foregoing instrument was acknowledged before me this day of <br />by <br />as of <br />Notary Public <br />My Commission expires: <br />SIGNATQFiES MAST BE IN BLVB INK <br />04/25/97 2821FCO.110 <br />Title: Owner <br />