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Certification: <br />-6- <br />As an authorized representative ofthe applicant, I hereby certify that the operation descaibedhas rrxx themimmum nequiremenis of <br />the following terms and conditions: <br />1. All racessary approvals Enna local government have been applied for (Secxiaut 3432.5-110(1)(a)(VIII). <br />2. To the best of my lmowledge, all significant, valuable and permanent man-made structure(s) in exisleace at the time this <br />application is filed, and located within 200 feet of the proposed affected area have been idemaified in this application <br />(Section 3432.5-115(4)(e), C.RS.). (NOTE: For 110 operations, the affected area inchrdes all lands delineated by the <br />permit boundary.) <br />3. No mining operationwillbelocated onlands where such operations areprohibited by law (Section 3432.5-115(4xf), <br />C.RS.). <br />4. As the applicant/operator, I do not have any mining/exploration operations in the State of Colorado cwrently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials <br />(Section 3432.5-120, C.RS.). <br />5. I understandthat statemcets in the applicatiout are beingmade underpenalty ofpe{jmy aadthat false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. 1984. <br />TTiisforsnhas been approved by theMaredLandRedanwtion Boardpwswantmsedion3¢325-I10,C.RS, oftheCalorado <br />Land ReclamatioreAdfortheEdradionofConstnirlionMateriaLv. Awyalrerationoramd~icav'oaofthiefmms-raRsesuk <br />in voiding any permit issued on the altered or n:odrfied form and swbjed the operator to cease and delis! orders and civil <br />penalties for operating without a permit pwtswmw to section 34-32-123, GRS <br />Signed and dated this _ day of ~O ~ ~~~~ <br />1~afe~C~<~~ <br />ApplicanbOperator <br />Signed(~~~_ ~a <br />Title: ~~2~t.1~/ <br />State of ~.J~u~-r~-~o ) <br />) ss. <br />County of ~c~.QaS~ ) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing inetrnmrnt was aclmowledged before me this _~_ day of iolh vv 5 <br />by Wu e. S eQnti.~ Q.r as Ow ~+ ¢ r• of 5~~.., a,... G, r.f.-ETUc~,Ln <br />~'6 -a tit L~~~ ..,.,,, <br />Notary public <br />I£ Corporation Attest (Seal) <br />Sigoetl: <br />My Commission expires: 11. L • l~n <br />SIGNATURES MUST BE IN BLUE INK <br />M:~minlshare\v~'om'~lCoosauctimlt0 (07/282pQ4) <br />