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RECE9VE® <br />'6' MAR 27 200'1 <br />Certification- <br />Oivhioe of Mimrrala exd OeoloBY <br />Ae 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(s) <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(4j(fj, C.R.S.j. <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 />5. Z 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. <br />Signed and dated this ~ day of /Z~.,.- , ~~ 1~'G <br />~~r.. If Corporation Attest (Seal) <br />Signed: <br />Title: <br />Signed: <br />/) <br />State of ( ~ ) <br />ss <br />County of ~~~ ) <br />Corporate Secretary or Equivalent <br />Town/city/County Clerk <br />The foreg~oi~nn~g ~'ins~tpr.~ument was acknowledged before me this ~~ day of /'~~2c~L't°~~~L , ~, <br />by ~tAilbP,O~'1 hRR[ ~'~ • as ~l~ of `~'-~r~'-~ #02 <br />Notary Public , <br />Hy Commission expires: °~~ ~~ <br />SIGNATQitES HQST SS ZH SLIIE INR <br />01/02/96 2823FC0.110 <br />