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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 the <br />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 knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time this <br />application is filed, and located within 200 feet of the proposed affected azea have been identified in this application <br />(Section 34-32.5-115(4xe), C.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by the permit <br />boundary.) <br />3. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-I 15(4)(fJ, C.R.S.). <br />4. As the applicanUoperator, I do not have any mining/prospecting operations in the State of Colorado currently in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.RS.). <br />5. 1 understand that statements in the application aze being made under penalty of perjury and that false statements made herein <br />aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS 1984. <br />Signed and dated this 2 4 ~h day of ~zbr-t1 Q r V x.000 , <br />Mr'rl i i n e L~t5 u) - F~Zn u i-f N . F. <br />ApplicanUOperator <br />Si <br />Title:1/~AC'n. ~~S~icf qa Q/l <br />TY i o <br />If Corporation Attest (Seal) <br />Siged: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of ` b ~o /~ e e-) o ) <br />ss. <br />County of ~~ c f</'9 ,. ) <br />Th^e}-forgoing instrument was ackno/wledged before me this ~ day of 7~ fJ,- ~ ~ i._ (~ , Z.a6 L~ . by <br />1 ~ O M4 )• ~ ~~ Il ~ as V~ /trd /~1/l aim/ , /~ Of C.l S <br />//Y iw ~w ~C.iC~--~R <br />Notary Pu lic <br />My Commission expires: G 3 7-e'ts~p <br />M:U1WlSHARE\VSFORM S12821COIO.APP 0: <br />BE IN BLUE INIC <br />