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-6- <br /> Certification: <br /> As an authorized representative of the applicant, I hereby 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). <br /> 2. To the beat of my knowledge, all significant, valuable and permanent man-made structure(a) <br /> in existence at the time this application is filed, and located within 200 feet of the <br /> proposed affected area have been identified in this application (Section 34-32.5-115(4) (e), <br /> C.R.S.) • (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 by law <br /> (Section 34-32.5-115(4)(f), C.R.S. ). <br /> 4. As the applicant/operator, I do not have any mining/prospecting operations in the State <br /> of Colorado currently in violation of the provisions of the Colorado Land Reclamation Act for <br /> the Extraction of Construction Materials (Section 34-32.5-120, C.R.S. ) . <br /> S. I understand that statements in the application are being made under penalty of perjury <br /> and that false statements.made herein are punishable as a Class 1 misdemeanor pursuant to <br /> Section 18-8-503, C.R.S 1984. `"` AUi,,,� <br /> / � uc l� <br /> Signed and dated this i. l day of , ��. *l 1, : <br /> pplp'hi If Corporation Attest�;(��a1•)•�••' t <br /> A scant/Operator y//�, •. b� t <br /> Signed: yL 1/` a/ Ohl 'c- /l �4 <br /> I� Corporate Secretary or Equivalent <br /> fA Title: -Pre' f C i t .T Town/City/County Clerk <br /> State of (1-0 (n fa d n ) <br /> PI F ' <br /> County of A.' it ) ss /J / <br /> The foregoing 1insltrum1ent was acknowledged beforeme this day of hlldii-sl <br /> by [ �[ ( ., lh lA t(� as I Le.3 eit 7 of (' . B' �T C,(ii:•P Rod",-TA( <br /> =?.g� a �Z�`•., Notary Public <br /> ,g f Hy Commission expires: <br /> e /.3 <br /> 40;A SUBLAC a <br /> ''•'� or •COVOQ.?, SIGNATURES HOST BE IN BLUE INK <br /> 01/02/965=FCo.110 <br />