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6- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the mulinmm requirements <br />of 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 k-rro;vledge, all significant, valuable and permanent man-made structure(s) in existence at the time <br />this 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 azea includes all lands delineated by the <br />p, mit boundan'.) <br />.. do reining opere5an n-i1 :;e located on lands v;here such operatiols are prohibited b} law (Sec~ion 34-32.5-115(`)(f), <br />CRS.). <br />". As the applicant/operator. I do not have ally mining/prosnecting operations in the State of Colorado currently in <br />c iolation of the provisions of the Colorado Land Reclamation Act for the Ea-traction of Construction Materials (Sect ion 34- <br />32.5-120, C.R.S.). <br />5. I understand that statements in the application aze 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.R.S. 1984. <br />Signed and dated this <br />day of December <br />2003 <br /> <br /> i <br /> ~ <br />r- <br />J <br />If Corporation Attaast (Seal) ti ~ 5 <br />y <br />~~ :, _ <br />{~. r <br />` <br />~ <br />=s <br />; <br />::; <br />Si <br />d <br />4 <br />~~'a <br />o <br />Q ~ <br />ue <br />. <br />. <br />. <br />gne <br />: <br />~ <br />... <br />:. <br />Don Blake <br />Applicant/Operantor <br />signed: ~8y~,~Y~ . <br />Title: ~ .~ ~ra2 Q~n'l . <br />State of ~~ e.r ~~ c, ) <br />ss. <br />County of ~ n e::~ r ) <br />Corporate Secretary or Equivalent <br />Touv/Gity/County Clerk <br />The f-o}r~egoing instrilment was acknowledged before me this Ste- `day of 'Da c e`..,.~•(r1 ~ \ , ~ n3 , by <br />1J[v'~~~n~GC~ a5 ~..AL l.~Sc ~c~m~ni S~V'o,-W~ Of UYL CDIv~ ~-yv---t+-i <br />o <br />Notary Public <br />My Commission expires: ~~ . ~ ~ , ~et~ <br />SIGNATURES MUST BE IN BLUE INK <br />hL\mm\sl~are\vsforms\Cw.s0uc2ion110 (10/15/2001) <br />