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6- <br />Certification: <br />As an authorized represartative of the applicant I hereby ceaGify that the operation desar~bed has mei the minimum requiranents <br />of the following tams and conditions: <br />1. All necessary approvals from local government have been applied for (Section 34-32.5-1 ] 0(1){a)(viii), <br />2. To the best of my lmowledge, all significant valuable and permanent man-made strucbue(s) in existence at the time <br />this application is Sled, and located within 200 feet of the proposed affected area have bees identified is this appflcation <br />(Section 3432.5-115(4xe), C.RS.). (NOTE: Fos 110 operations, the affected area includes all lands delineated by the <br />Permit boundary.) <br />3. No mining operation will be located ~ lands where such operations are prohibited by law (Section 34-32.5-115(4xf), <br />C.RS.). <br />4. As the app&cant/operator, I do not have any atining/prospeeting operations is ttte State of Colorado qtly in <br />violation of the provisions of the Colorado Lama Reclamation Act far the Extraction of Conshuction Materials (Section 34 <br />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 />Signed and dated this __~__~_ day of ~~Q i ~ . _. <br />:~~~- <br />;~' -• ~. <br />,; __ `;l <br />If Corporation Attest (Ses1)= , c ~ ~.. - <br />orate Secretary or Equivalent <br />Town/City/County Clerk <br />State of ~_OL-02fYd 0 <br />ss. <br />County of ~6ULb£,(/ ) ' <br />The foregoing instrument was acknowledged before me thiis ~ ~ day of ~-~J~-~-f , ~~ Y , by <br />~ ~ ~ Q n c rc,- as ~ Y~,~ Gf >°-s~v'~'~ of ~~o ~ .S'~n ~ <br />ppY PVB~ <br />~~~.,,.. '..,,/l+ <br />t, otary Public <br />:KATHERINE: <br />_: E. WHITE ~ Commission expires: % 3~~0~ <br />M:~r~.Bt'«~muo traitsrmoi7 <br />1N BLUE INK <br />