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Certification: <br />6- <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum <br />requirements of the following terms and conditions: <br />1. All necessary approvals from local govemment 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 structure(s) inexistence at the time <br />this application is filed, and located within 200 feet of the proposed affected azea have been identified in this application <br />(Section 34-32.5-I 15(4)(e), C.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by the <br />permit boundary J <br />3. No mining operation will be located on lands where such operations are prohibited by law (Section <br />34-32.5-115(4)(t), C.R.S.). <br />4. As the applicant/operator, I do not have any 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 Constmction Materials <br />(Section 34-32.5-120, C.R.S.). <br />5. I understand that statements in the application aze being made under penalty of perjury and that false statements <br />made herein are punishable as a Class I misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />This form hos been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-110,C.RS., of the <br />Colorado Land Reclamation Ad for the Extraction ojConstruction Materials. Any akeration or modification ojthisform <br />shall result in voiding any permit issued on the altered or modified jorm and subject the operator to cease and desist orders <br />and civil penalties jor operating without a permit pursuant to section 34-32-113, C.RS. <br />Signed and dated this t L ~ day of ~n~,~, Z (~!~ S <br />_ ~~~ $~~ If Corporation Attest (Seal) <br />A anU era <br />Signed: Signe <br />Corporate cretary o Equr nt <br />Title: V .(,wG~ ~ 4~1~ Town/City/County Clerk <br />State of rnp~prn goo ) <br />/ ss. <br />County of ~~ r!! i~S ) <br />The foregoing instrument was acknowledged before me this 2~ !'~ day of ~Lr- "" ~~,~.s <br />2S,7cu L " i` 1'J,PJLt7~C~ -=('t~G !"~ <br />~~~~~~ <br />Notary Public <br />My Commission expires: oZ ~a~G <br />SIGNATURES MUST BE IN BLUE INK <br />