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<br />- 6 - <br />Certification: <br /> <br />As an authorized representative of the applicant, I hereby certify that the operation <br />described has met the minimum requirements of the following terms and conditions: <br />1. All necessary approvals from local government have been applied foz <br />(Section 34-32.5-110(1)(a)(viii). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made <br />structure(s) in existence at the time this application is filed, and located within 200 <br />feet of the proposed affected area have been identified in this application (Section 39- <br />32.5-115(9)(e), C.R.S.). (NOTE: For 110 operations, the affected area includes all <br />lands delineated by the permit boundary.) <br />3. No mining operation will be located on lands where such operations are prohibited <br />by law (Section 39-32.5-115(9)(f), C.R.$.). <br />4. As the applicant/operator, I do not have any mining/prospecting operations in the <br />State of Colorado currently in violation of the provisions of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, <br />C.R.S.). <br />Signed and dated this <br />Title: COMMISSIONEL2 <br />State of COLORADO <br />County Clerk <br />~ ss <br />County of KIT CARSON ) <br />The foregoi/Jn~~g instrument was acknowledged before me this d day of /99.x, <br />by Qi(~YU AfLt,A2~1hCv as ~.9u.rie. Arrr~„n„nn,~m-,e ti) of ~y'N C~~.+.~»._) C~~y~,, <br />O_ <br />~ Notary ublr~ ~ - <br />` ., ~. <br />My Commission expires:`%,.' ir•r;7F71~='j= <br />SIGNATURES MUST SE IN BLUE INR <br />If Corporation <br />09/25/97 2821FC0.110 <br />5. I understand that statements in the application are being made under penalty of <br />perjury and that false statements made herein are punishable as a Class 1 misdemeanor <br />pursuant to Section 18-8-503, C.R.S 1989. _~~_ <br />