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n <br />6- <br />Certificafion: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum n;quuentents 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 Imowledge, all significant, valuable and permanent man-made stmctlne(s) in existence at the time this <br />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. (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 bylaw (Section 34-32.5-115(4xf), <br />C.R.S.). <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.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.R S. 1984. <br />Signed and dated this l4f rti day of ~ ~ O D ~ - <br />~tv~eA'S ~k~•avRYi~ <br />Applicant/C~perator <br />Signed: <br />Title: S~ OG1/ti~~' <br />State of C'01-~02AD <br />ss. <br />Countyof_ C~5`1L,~A ) <br />ff Corporation Attest (Seal) <br />Signed: --C~ ~ ~~, ~-{ ~ <br />Corporate Secretary or Equivalent <br />Town/City/Coun_ ty CI_ erk _ <br />The foregoing instnrment was aclmowledged before me this _l U4J L day of / r l ~ a~ by <br />~~ll/PVri, as of `~ <br />~T~~ <br />ANIVETTE CARI~O <br />RIOTARY PUBLIC <br />STATE OF COLORADO <br />&A`! C6M'flSSlr3id EXPIRES 12-0508 <br />M:\min~share\vsfom~s\Co~uction110 (05/06/2003) <br />Notary Public <br />My Commission expires: o~ ~ ~~o <br />SIGNATURES MUST BE IN BLUE INK <br />