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Certification: <br />-6- <br />L~~J <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of <br />the following terms and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-110(1)(a)(VIII). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made stmcture(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(4)(e), C.RS.). (NOTE: For 110 operations, the affected area includes all lands delineated by the <br />permit 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.RS.). <br />4. As the applicantJoperator, I do not have a~ mining/exploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials <br />(Section 34-32.5-120, C.RS.). <br />5. I understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. 1984. <br />77ris form has been approved by theMined Land Reclamation Board pursuant to section 3¢32.5-IIO,CRS, ofthe Colorado <br />Land ReclamationAdfortheF.xlractionofConstructionMaterials. Anyakerationormor&frcationofthisformshaQresuk <br />in voiding any permit issued on the akered or mod~ed form and subject the operator to cease and desist orders and civil <br />penalties for operating without a permit pursuant to section 332-123, CRS <br />Signed and dated this ~ day of ~~.6-- U ~~ <br />ApplicantlOperator D D, <br />Signed(~~_ G~G(~C./ <br />If Corporation Attest (Seal) <br />Signed: <br />Title: ~~2.1.~/ <br />State of Wes!-va~~o ) <br />) ss. <br />County of ~tS..QAS~ ) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this ~ day of _ -t,aX~ Jo S <br />by Wa e. S cXiw~ e.r as Ow 7` a r• of S r ~.~.~ a,« Ca r.S-Eruc~,un <br />~r,.:m ~ ~~.~g.d1,t1.,„, <br />Notary Public <br />`~ -_ <br />My Commission expires: l 1. L • tin <br />SIGNATURES bIUST BE IN BLUE INK <br />M:~~~~r~~c~w~on~rolo~nsnooa> <br />