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-G- <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 terms and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.x-110(1)(a)(viii). <br />2. To the best of my lmowledge, all significant, valuable and permanent man-made stmcture(s) in existence at the time <br />this application is filed, and located within 200 feet of the proposed affected azea have been identified in this application <br />(Section 34-32.5-115(4)(e), C.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by the <br />permit boundary.) <br />3. No nrining operation will be located on lands where such operations are prohibited by law (Section 34-32.>-115(4)(f), <br />C.RS.). <br />4. As the applicandoperator, 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 penalty of perjury and wat false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 15-8-503, C.RS. 1984. <br />Signed and datedthis ~ l~ day of ~o~~~,..-~~.-~c~ ~ O o 3 <br />AppficandOperator <br />Signed: ~ ` <br />Title: C 1{/k ~ R M aka,{ <br />State of ~r~c.--oR.4;tra ) <br />ss. <br />County of FREru o-r! ,~ ) <br />The foregoing instrument was aclmowledged before me this ~ day of , a ate, by <br />t~.~~ ~1 <br />r. ~. ^-f~;'~.Y~t6i/~Ly as `J=r~4i iynd rr~y~ of ~P' lotil' c + - <br />- - , ''y - Notary Public ~~~ <br />~~ %, - My Commission expires: <br />,,, - __ <br />SIGNATURES MUST BE IN BLUE INK <br />If Corporation Attest (Seal) <br />