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EECEIVEC <br /> 6 — <br /> Certification: CNIS:on of Minerala R G% <br /> As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br /> following terns 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, all significant, valuable and permanent man-made structure(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.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by the permit <br /> boundary.) <br /> 3. No mining operation will be located on lands where such operations are prohibited by law(Section 34-32.5-115(4)(f),C.R.S.). <br /> 4. As the applicantloperator, I do not have any mining/prospecting operations in the State of Colorado currently in violation of <br /> the provisions of the Colorado Land Reclamation Act for 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 and that false statements made herein <br /> are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503,C.R.S 1984. <br /> Signed and dated this day of . <br /> EVAN I._ MET.RY. INC. If Corporation Attest(Seal) - <br /> Applicant/Operator <br /> Sign Siged: 4 "rA fi- lb <br /> ji <br /> Corporate Secretary or Equivalent <br /> Title: PRESIDENT / Town/City/County Clerk <br /> State of ( O1D f-o dU ) <br /> County of L DJ T/ ��Gb )ss. <br /> The foregoing instrument was acknowledged before me this J` Th day of S 9. by <br /> Q ( as PES/OFVT of 9VAN L.. MELB i �uC. <br /> N tary Public <br /> My Commission expires: azlix <br /> SIGNATURES MUST BE IN BLUE INK <br /> M-\M N\SHARE\VSFORMSQ921COIO.APP 02/10/99 <br />