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-6- • <br />Certification: <br />As an authorized representative of the applicant, I 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) C.R.S.). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made <br />structure(s) in existence at the time this application is filed, and Located within 200 <br />feet of the affected are have been identified in this application (Section 34-32.5- <br />115(4)(e), C.R.S.). (NOTE: For 110 operations, the affected area includes all lands <br />delineated by the permit boundary.) <br />2. No mining operation will be located on lands where such operations are prohibited <br />by law (Section 34-32.5-115 (4)(f ), C.R.S.). <br />3. As the applicant/operator, I do not have any extraction/exploration operations in <br />the State of Colorado currently in violation of the provisions of the Colorado Land <br />Reclamation Act for the Extraction of Constructions Nateriale (Section 34-32.5-120, <br />C.R.S.). <br />4. I understand that the statements in the application are being made under penalty <br />of perjury and that false statements made herein are punishable as a Class 1 <br />misdemeanor pursuant to Section 18-8-503, C.R.S 1984. <br />Signed and dated this ~ day of <br />A icant/oper or <br />By: Ferd A. Mueller <br />Title: Agent <br />State Of COLORADO ) <br />ea <br />County of FREMONT ) <br />If Corporation Attest (Seal) <br />By: /l/ A <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The forgoing instrument was acknowledged before me this 7St day of October 1997 , <br />by Ferd A. Mueller ae an Agent of Siloam Stone <br />r. n11...,;. <br />~ : ...... ~h'.^ <br />,:~ C;~rQ,?,,~':•7 Notary Public <br />- W $ ~~~. Hy Commission expires:AuquSt 9, 1999 <br />,. •. <br />SIGNATURES MUST BE IN FLUE INR <br />, '~ <br />04 /5/97 7871FC0.130 <br />