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- 6 - <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br />following terms and conditions: <br />I. All necessary approvals from local govenmrent have been applied for (Section 34-32.5-110(1)(a)(viii). <br />2. To the best of my Imowledge, 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 ident~ed in this application <br />(Section 34-32.5-1 h(4)(e), C.RSJ. (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 aze prohibited by law (Section 34-325-1 IS(4)(f), C.RS J. <br />4. As the applicantloperator, I donot 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 E.~rGraction of Construction Materials (Section 34-32.~-120, C.RS.). <br />5. I understand that statemetts in the application are being made under penalty of perjury and that false statements made herein <br />are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS 1984. <br />Signed and dated this % ~ day of ~~ d t°/;~ 2 0 ~2 ! /~, <br />_ Rin Rlanrn (`nnnty Road and Bridge <br />Applicant/C~perator <br />If Corporation Attest (Seal) <br />K ~ st .1.Gcr~~/ ri <br />Stanle~asmussen <br />Supervisor <br />of Colorado 1 <br />ss. <br />tvof Rio Blanco <br />Signed: <br />Corporate Secretary or Equivalent <br />TownlCity(County Cterk <br />foregoing instrument was aclmowledged before me this ~B~ day of ~~~.c12- ~.o°~' , by <br />Stanley Rasmussen as Supervisor ~i/oQB'lanco County <br />' ~ ~ ~ tY ' v Notary P~iblic <br />'~ = <br />=_ - ~ ~ r.. My Commission expires: MV COmtIllSSiOtt (t&4 <br />''!~~''r ~' ~ `~ ``~~~ SIGNATURES MUST BE IN BLUE INK <br />lCOl0.APP 06/25/99 <br />