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~^ / <br />~-' <br />-6- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements <br />of the following teams and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-1 l0(1)(a)(viu). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time <br />this 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 I10 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.RS.). <br />4. As the applicant/operator, 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 (Section 34- <br />32.5-120, C.RS.). <br />5. I understand that statements in the application are being made under penahy of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. 1984. <br />Signed and dated this ~ day of - ~L1C7 ~ <br />ApplicandOperator <br />Signed: <br />Title: ~e~~Yi! <br />State of l G~c7 ) <br />nn ) ss. <br />County of GCCJ 6~'cv~~- ) <br />If Corporation Attest (Seal). <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />Th/e //foregoing instrument was aclmowledged before me this ~ 'u-' day of _ <br />Y~A/LI.~, YJCtt/i`oC~/Lct3 as C9UIYU-/ of <br />O <br />Notary Public <br />My Commission expires: <br /> <br />~, by <br />~• <br />''~~~ ~ <br />3/ .'die _._ <br />SIGNATURES MUST BE IN SLUE INK <br />M ~~n~~~«~~c~a...»;Miio tionsizooi~ <br />