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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 min;rm,m requirements <br />of the 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 stmcture(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.RSJ. (NOTE: For 110 operations, the affected azea includes all lands delineated by the <br />pc:mit boundary.) <br />_. No run:ng operation will ~^,e located on lands where sach op~ ations aze prohibited by law (Se.~on 34-32.5-115(')!x, <br />C.RSJ. <br />4. As the applicant/operator, I do not have any mining/prospecting operations in the State of Colorado curren~\v in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Constmction 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 are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. 1984. <br />Signed and dated this 5 day of December <br />Don Slake <br />Applicani/Op(~era~tor <br />Signed: tVqu~ -~ ll/~ . <br />2003 <br />If Corporation Attest (Seal) <br />Signed: <br />Title: ~ ~ ~,Q a2 ~!~'( . <br />State of ~~ eva~ a ) <br />ss. <br />County of 1-^ n c.;;1 n 1 <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />..4.. <br />The foTregoing instrument was acknowledgeld before me this S - `day of ~D2 c e`..~.~r/~ ` , ;fir n3 , by <br />Le.l~~1r.~ce.. as L-a:-9L I.CSt 1A~1 .v.~r~~s'~ra.+W pg ~AV~(-alr~ ~-Qv--~"i <br />Notarv public <br />My Commission expires: ~-1,~ . ~~ , ~.ccs <br />SIGNATURES MUST BE IN BLUE INK <br />M\mmishare\vsfamslCwsl~uciim110 (10!15/2001) <br />