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6 — <br /> Certification: <br /> As an authorized representative of the applicant, 1 hereby certify that the operation described has met the minimum requirements of the <br /> following terns and conditions: <br /> I. All necessary approvals from local government have been applied for(Section 34-32.5-1 10(I)(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 34-32.5-1 15(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 applicant/operator, 1 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 I misdemeanor pursuant to Section I8-8-503,C.R.S 1984. <br /> Signed and dated this 0 day of 'S. q q <br /> 2ow� b If Corporation Attest(Seal) <br /> Applicant/Operator <br /> Signed: Siged: <br /> Corporate Secretary or Equivalent <br /> Title: oV t\c-C Town/City/County Clerk <br /> State of C o\o ) <br /> )ss. 5 Zy ' 7z - Z12.1 <br /> county of L QP 6x'r' ) <br /> The foregoing instrument was acknowledged before me this 3 day of_ �A I q 9 i , by <br /> Q N.o_ Z_;� as of hl n a�lka�. <br /> Notary Public <br /> My Commission expires: ( n�z 00419'_ <br /> SIGNATURES MUST BE IN BLUE INK <br /> M:\MD- SHARE%VSFORMS\2821COIO.APP 02/10/99 . <br />