PERMFILE62341

• Permit No: M1996073
• IBM Index Class Name: Permit File
• Doc Name: CONSTRUCTION MATERIALS LIMITED IMPACT OPERATION 110 RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

-6-
Cert if icat ion:
As an authorized representative of the applicant, I hereby certify that the operation described
has met the minimum requirements of the following terms and conditions:
1. All necessary approvals from local government have been applied for
(Section 34-32.5-110(1)(a)(viii).
2. To the beet of my knowledge, all significant, valuable and permanent man-made structure(s)
in existence at the time this application is filed, and located within 200 feet of the
proposed affected area have been identified in this application (Section 34-32.5-115(4)(e),
C.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by the
permit boundary.)
3. No mining operation will be located on lands where such operations aze prohibited by law
(Section 34-32.5-115(4)(f), C.R.S.).
4. As the applicant/operator, I do not have any mining/prospecting operations in the State
of Colorado currently in violation of the provisions of the Colorado Land Reclamation Act for
the Extraction of Construction Materials (Section 34-32.5-120, C.R.S.).
5. i understand that statements in the application are being made under penalty of perjury
and that false statements made herein are punishable ae a Class 1 misdemeanor pursuant to
Section 18-8-503, C.R.S 1984.
Signed and dated this ~~_ day of 5~~,~0~,.. ~PY , CC
Se~c.w~ck Cov.~+y
Appli too/Operator
Signed: ~ ~--~-~-~/ ~'~
Title: ~.Tpr V ~Ct~\r
State of C_d ~ h V'n Cl )
1 ) ss
County of ~ )
The foregoing i trvment was acknowledged before me this /L,_ day of _Lle~j ~~•
by as ,(~l~i),(Xi11S'~ of
of/a¢/~ asziFCO.uo
If Corporation Attest (Seal)
Signed:
Corporate Secretary or Equivalent
Town/City/County Clerk
J Notary Public
My Commission expires: 1~3,' c~~-~~
SIGlUITURES MIST BS IN BLUE INR
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