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-6- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has roet the roinimwn requa~nents of <br />the following teems and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-110(1)(a)(viii). <br />2. To We best of my knowledge, all significant, valuable and permanent man-made strncture(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 34-32.5-115(4)(e), C.RS.). (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 (Section 34-32.5-115(4~f), <br />C.R.S.). <br />4. As the applicant/operator, I do not have arry mining/prospecting operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials <br />(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 <br />herein are punishable as a Class 1 misdemeanor p~usuant to Section 18-8-503, C.RS. 1984. <br />Signed and dated this <br />10th <br />day of <br />June 2004 <br />John M. Everitt <br />Applicant/Operator <br />Signed: / <br />Title: <br />State of Colorado <br />ss. <br />County of Phillips <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instnrment was aclmowledged before me this 10th bey of June 2004 by <br />John M: Everitt ~ OwnerJOperator pf Everitt Pit <br />", _ ,- Notary Public <br />My Commission expires: 7 / 2 3 / 06 <br />If Corporation Attest (Seal) <br />Signed: <br />SIGNATURES MUST BE IN BLUE INK <br />nr:~~~war~~c~n,a~iio tosioci2oosl <br />