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RECEIVED <br /> Q 1 -6- <br /> Certification: APR <br /> R <br /> aakk g GeobgY <br /> As an authorized MOM" ve of the applicant, I hereby certify that the operation described <br /> 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 structures) <br /> in existence at the time this application is filed, and located within 200 feet of the <br /> proposed affected area have been identified in this application (Section 34-32.5-115(4) (e) , <br /> C.R.S. ) . (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 <br /> (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 State <br /> of Colorado currently in violation of the provisions of the Colorado Land Reclamation Act for <br /> the Extraction of Construction Materials (Section 34-32.5-120, C.R.S. ). <br /> S. I understand that statements in the application are being made under penalty of perjury <br /> and that false statements made herein are punishable as a Class 1 misdemeanor pursuant to <br /> Section 18-8-503, C.R.S 2984. <br /> Signed and dated thi day of fLL. <br /> i <br /> If Corporation Attest (Seal) <br /> Apiis t/Operator <br /> Signed: Signed: <br /> Corporate Secretary or Equivalent <br /> Title: Town/City/County Clerk <br /> State of <br /> ss <br /> County of ) / <br /> The foregoing instrument was acknowledged before me this �/ day of <br /> by�UC n P- IDS as t)OJA77.k of P ITF,S qANCAl727 4U <br /> 0 <br /> N ary/ <br /> My Commission expires: <br /> SIGNATURES MUST BE IN BLUE INK <br /> 01/02/96 2621FOO.110 <br />