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-G- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimtmt requirements <br />of the following terms and conditions: <br />1. 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 <br />this application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(4)(e), C.RS J. (PIOTE: For 110 operations, the affected azea includes all lands delineated by the <br />permit boundary.) <br />3. No mining operation will be located on loads where such operations aze prohibited by law (Section 34-32.5-115(4)(f), <br />GRS.). <br />4. As the applicanUoperator, I do not have any 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 Constntction 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 aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. 1984. <br />Signed and dated this 5~r day of ~r„> 2oD2 <br />u; ck Ensminver if Corporation Attest (Seal) <br />ApplicanUOperator <br />signed: j,,~ ~ - - --- -,. ~ signed: <br />Corporate Secretary or Equivalent <br />Title: Owner /Operator Town/City/County Clerk <br />State of (;olorado ) <br />) SS. <br />County of Phillips ~ <br />The foregoing instr+tment was acknowledged before me this Jr ~ day of Diin,.C Zao2 , by <br />RicL{ >=ytsmtutaer as Ownu~ (9prrm>Lar of ~nsnniutcter f'6~ <br />~- Ja <br />Notary Public ;_ ; ~ ,.. < j., <br />My Commission expires: -2 ~/ ~ 1r?_=, <br />SIGNATURES MUST BE IN BLUE INK <br />