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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 rminimum requirements of <br />the following terms 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 knowledge, all significant, valuable and permanent man-made strucn¢e(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(4)(e), C.R.SJ. (NOTE: For 110 operations, the affected azea 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 taw 1 Section 34-32.5-I I5(4}(~, <br />C.R.SJ. <br />4. As the applicant/operator, 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.R.S.). <br />5. I understand that statements in the application aze being made under penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pwsuant to Section 18-8-503, C.R.S. 1984. <br />Signed and dated this ~ day of , <br />~t,) ~c ~4KQ <br />Applicant/Operato~r (') <br />Signed: tJ't~ <br />Title:1---~.~ ~ S ~ "rJ m <br />State of ~~~-~~ <br />ss. <br />County of ~ r ~` r ) <br />If Corporation Attest <br />Signed: <br />.` •, <br />.~ '~': <br />• ro \ -- <br />Y - / <br />^^ <br />~~f!~~. <br />Corporate, Secretary or Equivalent <br />Town/Ci /County Clerk <br />The foregoing instrument was acknowledged before me this 3`~% day of __~A ~ , 7~5 by <br />~~e.-~ 31a~ as ~-a„'~~ 1~lsr ~a w~1 r; ~~~v.- of _~.~,-. c ~~ ,.T ~ u~~t"`.`4 <br />Notarv Public <br />My Commission expires: ~~ . ~`F ~oS <br />SIGNATURES MiIST BE IN BLUE INK <br />M:\ntin~share\vsfomts\Cot~r4uclion110 (OS106/2003) <br />