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RECENED <br />APR12 2007 <br />-, _ <br />Division of ReclatnaUOn, <br />Certification; Mllling and Safety <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br />following terms and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-110(I)(a)(VIII). <br />2. 'fo the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time dtis <br />application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(4)(e), C.R.S J. (NOTE: por 110 operations, the affected area includes all lands delineated by the permit <br />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.R.S.). <br />4. As the applicant/operator, I donor have any mining/exploration operations in the State of Colorado currently in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S J. <br />5. I understand that statements in the application are being made under penalty ofperjury and that false statements made herein <br />are punishable as a Class l misdemeanor pursuant to Section 18-8-503, C.R.S. 1984, <br />This form has been approved by the Mined Land Reclamation Roard pursuant to section 34-32.5-11 D,C.RS., ofthe Colorado Land <br />Reclamation Act for [he Extraction of Construction Materials. Any alteration or modification of this jorm shall result in voiding <br />any permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penahies for <br />operating without a permit pursuant to section 34-32.5-123, C:R.S. <br />Signed and dated this L~ day of 'r--t RSA 1l Ct~~ <br />Applican~UO~peratoc <br />Signed• '~ / <br />Title: OW ` rC/y <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />TowniCity/County Clerk <br />State of l_L`~~\~ ) <br />County of ~f'P-(~~Ol'l~ ) )s. <br />'fhe foregoing instmme1'nt was ackmwledged before me this ~ 1.~ day of ~~[~______ , <br />~~ by ~`.y.~0. ~~ as _~W'h2r of <br />My Commission expires: ltl l l e ~~t a~o~ _. <br />~~~~ a~ ~D za71 <br />-sux~ expd'es <br />SIGNATIIRF,S MOST BF. IN BLUE INK <br />M:~min\sharslvsFin'ms`.C;,mstruciimrll0 fAtrpttrved O51t 1/202 <br />