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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 <br />the following terms and conditions: <br />1. All necessary approvals from local government have been applied for (Section 34-32.5-110(1)(a)(viii). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made structure(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-I15(4)(e), C.R.SJ. (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 aze prohibited by law (Section 34-32.5- 115(4)(f), <br />C.R.S.). <br />4. As the applicanUoperator, I do not have any 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 aze being made under penalty of perjury and that false statements made <br />herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />Signed and dated this ~/~ day of ~ ~ _~~~~•-~~C, qc C'JO <br />Appli t/Operator <br />Signed: ~~ ~ ~ <br />~ /~ <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of ~U ~ a ~~' ~ s ) <br />ss. <br />County of ~l ~ P2~ } <br />The f/or/egoing instrument was aclaowledged before me this ~~ ~ day of S'Pp~f„ hP2 ,~e~~ ~ , by <br />/-lf~2j Q Sc~~/r2as ~O~~c,~~r/dt~r~Fl7ok' of Sc~~/t2 TE aci~ <br />-~ <br />~~~ <br />otary Public / " ~ <br />My Commission expires: ~/~ y /~ a O 7 <br />SIGNATURES MUST BE IN BLUE INK <br />M:~+nin~share\vsfom~s\Constructionll0 (OSr06/2003) <br />