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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 />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) m existence at the time this <br />application is tiled, and located within 200 feet of the proposed affected azea have been identified in this application <br />(Section 34-32.5-I l~(4)(e), C.R.S.). (NOTE: For l f0 operations, the affected azea includes all lands delineated b_v the permit <br />boundary.) <br />3. No [Wining operation will be located on lands where such operations aze prohibited by law (Section 34-32.5-1 I5(4)(f), C.RS.). <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 peryurv 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 ~ y I ~ day of J ~vtr u,~t r ~T ~-c9rrD , <br />~u ~rt~{„M ~~. <br />Applicant/Operator <br />Signed: <br />If Corporation Attest (Sea]) <br />Signed: <br />Corporate Secretary or Equivalent <br />Title: Di.iryil <br />State of LO~rfYn(IG ) <br />ss. <br />County of C~ro a d ) <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this 1,1/fti day of -~ A t:ta w R ~ L co c , by <br />_ ~lut 7usT as C,ten;P~ of 4'usT ~ ~gti~cu <br />- ~ - = Notary Public <br />- - - My Commission expires: .Z • /9 ZCbL% <br />\~~ <br />' " SIGNATURES MUST BE IN BLUE INK <br />M:Vv1IMSHAREIVSFORMS12821COl0APP 06125/99 <br />