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<br />-6- <br />Certification: <br /> <br />Ae an authorized representative 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 beet of my knowledge, all significant, valuable and permanent man-made structure(s) <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)(£), 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 />5. I understand that statements in the application are being made under penalty of perjury <br />and that false statements made herein are punishable ae a Claee 1 misdemeanor pursuant to <br />Section 18-8-503, C.R.S 1984. <br />Signed and dated this ~" day of ©G/ , , ~. <br />~ h,ef7'k"K fr/j~,Q~//~ D <br />/•~~p/~ ~~/~ If Corporation Attest (Seal) <br />Applicant/Operator <br />Signed: C16~7'1~1j4///~ /~ Signed: <br />Title: ~ 'v ly ~- / <br />State of ~'o~~ /'/~d o ) <br />/~ ) e s <br />County of U O lid 2! ~ > <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />strument was <br />n <br />The fore <br />go <br />in <br />g i acknowledged before me this ~ day of ~ccef~-~J , /996 , <br /> <br />~~ <br />¢¢ <br />__,, <br />/ <br />7 <br />by Ci~vyGr~/ U as ~~U~r n <br />r,til of / 1 ~ . <br /> ~ <br />~s~~~ r. wti~~_ <br />°~ Notary Public _ " <br />My Commission expires: ~ ~" <br />--i_ <br />SIGNATURES MUST BE IN BLUE INR <br />01/02/96 2821FC0.110 <br />