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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 minimum requirements of <br />the following terms and wnditions: <br />1. All necessary approvals from local government have been applied for (Section 34-32.5-110(I)(a)(vui), <br />2. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in e~s[ance at the time this <br />application is fled, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-I IS(4)(e), C.RS.). (NOTE: For I10 operations, We 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-I15(4xf), <br />C.RS.). <br />4. As the applicandoperator, I do not have arty mining/prospecting 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 ofperjury 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 /5 ~' day of ~~ ~~ ..?CC Sy <br />Phillips County <br />ApplicantlOperator <br />If Corporation Attest (Seal) <br />Signed. ~,L_Trte~. <br />Title: Phillips County Commissioner <br />State of Colorado ) <br />ss. <br />County of Phillips <br />Signed: <br />Corporate Secretary or Equrvalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this /5 ~sr day of ~ ~Cf~ by <br />Susan Roll as Commissioner of Phillips County <br />~o,~~ ~r ~'. ~~~ _ ~ -~__ <br />Notary Public ~ ~=' ~ - ; <br />My Commission expires: ~ , • ~": .Z' i :3 " :' 7 ; <br />' :~-~ - <br />SIGNATURES MUST BE IN BLUE INK ~ `~-."--~~~ ; ° <br />M:H,u,~~.~o~~c~„wonrrolosrocnoos> '~''~ . '.. <br />