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-~- <br />Certification: <br />As an authorized representative ofthe applicant, I hereby cerhify that the operation described has met the minimum requirements of the <br />following temis a{td conditions: <br />1. All necessary approvals from total 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 manmade structure(s) inexistence 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 Lmds where such operations aze prohibited by law (Section 34-32.5-1 I5(4)(f), <br />C.R.S.). <br />4. As dte applicaat/operaror, I do not have nay rr~ining/exploration operations in the State of Colorado currency 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 penaltyofperjuryand that false statements made herein <br />are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />This form has been approved by the Mined Land Reclamatlon Board pursuant to section 34-31.5-110,C.RS, ofthe Colorado Land <br />Reclamation Ace for the Extraction ojConstructlon Materia/s. Any alteration or modification of this jorm shall result in voiding <br />any permit Issued on the altered or modifred form and subject the operator to cease and desist orders and civil penalties jor <br />operating without a permit pursuant to seMion 34-32.5-123, C.R.S. <br />Signed and dated this Z~ ~'1 day of ~k ( ~~ <br />r If Corporation Attest (Seal) <br />A ]i <br />Signed: <br />Title: <br />State of ~a~~nfa>I[~ 1 <br />ss. <br />County of ~ tJ i ) <br />TowdCity/County Clerk <br />The foregoing instrument was acknowledged before me this ZS day of ~ (Lr! , <br />~~ by ~RL+ 1L ~,nQd ~ ~ as of <br />~OtpFY PU I <br />Jennifer otary Puh <br />~ Rudnik <br />q My Commission expires: C~ l3 nl (= .~U~~ ~~/ <br />Signed: <br />Corporate Secretary or Equivalent <br />'~ol~s_J4i Zt~O'7 <br />SIGNA~J'1' BE IN BLUE INK <br />M:Minlshare\vsforms\Conswclion110 (Approved 05/11/2005) <br />