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<br /> <br />- 6 - <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described <br />has met the minimum requirements of the following terms and conditions: <br />1. All necessary approvals from local government have been applied for <br />(Section 34-32.5-110 (1)(a)(viii). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) <br />in existence at the time this application is filed, and located within 200 feet of the <br />proposed affected area have been identified in this application (Section 34-32.5-115 (4)(e), <br />C.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by the <br />permit boundary.) <br />3. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-115 (4)(f), C.R.S.). <br />4. As the applicant/operator, I do not have any mining/prospecting operations in the State <br />of Colorado currently in violation of the provisions of the Colorado Land Reclamation Act for <br />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 <br />and that false statements made herein are punishable as a Class 1 misdemeanor pursuant to <br />Section 18-5-503, C.R.S 1984. <br />Signed and dated this ~ Q day of ~G yy, ](f.lM ~ 9 c! ~/ . ', =. <br />c.sl-4>-'~^. (~ ~ (4.*~"~-l., h'~ ~ /V I G C~ I lcb~ co -... <br />^CL rporation Attest (SeaT~).:- <br />(~Ap\,pl\icant/O(p~er~atorj~ ~~'n1 c~~'~ -~ - <br />Signed: _ )rlkffJ'~'x- V -~ ~ Signed: C_/~P.~. lU~(7~ - <br />D L Corporate Secretary or Equivalent <br />Title: 1 /~n~11.5 ~ ~ II1 Town/City/County Clerk <br />State of l,~I~V~LC~ ) <br />ss <br />County of ~ ~IG.A(t7 ) <br />The foreg <br />ing <br />o instru <br />ment was acknowledged befo <br />re <br />m <br />e this !~ day of <br />( <br />~ <br />/ <br />by ~C/VI W ~ l l <br />~ <br />/ • ~O c S as ~/l.Q/ {^ <br />n <br />~- <br />~-C. c~y~-~ of ~NC- <br /> <br /> <br />--- - '• <br />- _ ~~l': <br />,~~.. <br />1 . ^ <br />~~`nr .... .. -, <br />`CI,INYIp.. ~ LY(1J~~ <br />Not ry Public <br />My Commission expires: y~/aro/ <br />SIGNATURBS MIIST BH ZN BLIIE INK <br />03/19/97 2821FC0.110 <br />