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6- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation describedhas met the minimumrequ~ts of <br />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, aU significant, valuable and permanent man-made stnrchne(s) in existence at the time this <br />application is Sled, 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.RSJ. (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 (Section 34-32.5-115(4xf), <br />C.RS.). <br />4. As the applicant/operator, I do not have a~ mining/prospecling operations in the State of Colorado cinrently in <br />violati~ 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 of perjury and that Sdse statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. 1984. <br />Signed and dated this ~! day of ~V7 Y ~ ~ Z~. <br />~Sf//~ ~ih/.' <br />ApplicanUOper r <br />Signed. <br />Title: l~idnf~r- ~~~(~.n 7~ <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of ~o l~ /"Q ~0 l <br />~~~~ ) ss. <br />County of % ~C/fd_~ <br />The foregoing instrument was aclmowledged before me this / q ~ day of ~/ !~ ,[~~ ~ by <br />//!ilS6Y1 n~a3 ©!d/~ iYCGJ~ of i1/~1C /,"`/./• ~-~~~ <br />Notary Public :': `' ~• ~ -= <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />t~r:~~~~'a~~uaiant io tosrosnoosl <br />