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-6- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation descatbed has met the minimum requirements <br />of the following terms and conditions: <br />1. All necessary approvals from local government have been applied for (Section 3432.5-110(1)(a)(viii). <br />2. To the best of my ]mowledge, all significant, valuable and permanent man-made structure(s) in existence at the time <br />this apphcation is fled, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 3432.5-115(4xe), 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 bylaw (section 3432.5-115 (4)(f), <br />C.RS.). <br />4. As the applicant/operator, I do not have any mining/prospecting operations in the State of Colorado taurently in <br />violation of the pmvisians of the Cokaado Land ]tecclamation Ad for the Extrce4on of Construction Materials (Section 34 <br />32.5-120, C.RS.). <br />5. I understand that statements in the application are being made under penalty of perjury and that false statemwts made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. 1984. <br />Signed and datedthis / k day of Au ~ u 5 % SOD 3 <br />P.l~(-ki~L ~R.OWNt~G <br />ApplicanUOperator <br />Signed: / r" <br />Title: ~W.UB/L / Op E,Qr¢ 1-02 <br />State of ~' f.o 2 ~-D o <br />~~11 ~ ) ~- <br />County of LAS /'tN ~ M .4-~) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing inshvment was aclmowledged before me this (oT~t day of ~ u4 u~ S T ~3 , by <br />~~~tif1F~ as Our~DF, a~-iPJ2 of l~/ET ~Aro~D~I I"li~v< <br /> <br />..~. ^ , `, <br />~~ <br />:r--: .. <br />My <br />If Corporation Attest (Seal) <br />Signori: <br />expires: la-O ~- ~oo(o <br />SIG `AY11TiES MUST BE IN BLUE INK <br />M:~~.~'~~cooan~;mtto ttatsnoot~ <br />