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<br />- b <br />Certification: <br />~~1 <br />~` <br />QQ~,,~ ~'; <br />As an authorized rcpracntatice of the applicant. I hereby cenit< that the operation described .met dfcrt4lipimum rcyuircments of the <br />Co11o«ing terms and condmons: ~Oji°f ~ f <br />4, , <br />I. All necessary approvals Gom local goccrnment have been apphcd for (Section 3~-325-I lO(1`)(a)(~iti). <br />2. To the best oCma knowledge. all significant. valuable and permanent man-made structure(s) in existence at the time thts <br />applicauon is filed, and located within 200 feet of the proposed affcc[ed area have been identified in this application <br />(Section 3~1-32S-1 l~(d)(el. C.R.S ). (?JOTS: For 110 operations, the affected area includes all lands delineated b} the permit <br />boundary.) <br />No mining operation will be located on lands where such operations are prohibited b} law (Section 3y-3'_.5-115(y)(n, C.R.S.). <br />4. As the applicandoperator, I do not have anc mining/prospectingoperotions in the State of Colorado eturenth in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 3d-32.5-120, C.R.SJ. <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 1 misdemeanor pursuant to Section 18-8-503, CRS 198-1. <br />Signed and dated this ~ -C~~ 7l%t'~ day of ~~~u 2 c~ 07 <'~' <br />lCs1~7Y'~'hi t/l Yi' IL ~2zi~ ~"~Ct't.. sl'ii/C1 ' <br />~IicandOperator <br />If Corporation Attest (Seal) <br />~~,~J / <br />Signed: /C'~(1~~. Cl~,~ Q=-1 <br />Title: 7~ ~Cr/ ~= ez~~~. <br />State of ~~1~/12R,e~ ~, ) <br />'' II // ) SS. <br />Coun[<~ of ~JUC'.t'Y~iNc1 ) <br />Corporate Secretary or Equivalent <br />Town/Citt•/County Clerk <br />The foregoing instrumentwas acknowledged before me this ~ day of ~"Y~~U/~ ;'~7 , • b U , be <br />N+{~u,..y ~. ~'j~ft;,i as`tl ~flNgC~F'K of nl No f$ ~Ntt',~{r,', sPs <br />~~~ ~ <br />Not ~- <br />Ivh Commission expires: 'u-~`~G'-' . <br />SIGNATURES 61UST BE IN BLUE INK <br />M1I:~MINSFWRE',VSFORSI828'_lCOln.,aPP 06"?: 99 <br /> <br />Signed: <br />~ _. <br />