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- 6 - <br />Certif cation: <br />As an authorized representative of the applicant, [hereby certifi~ 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 34-325-110(I)(a)(viii). <br />2. To the best of my knowledge, all sir,,mificant, valuable and permanent man-made structure(s) in existence at the time this <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)(2), C.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by the permit <br />boundary.) <br />3. No musing operation will be located on lands where such operntions are prohibited by law (Section 34-32.5-1 li(4)(f), C.RS J. <br />4. As L4,e applicanUoperator, I do not have any mining/prospecturgoperatsons 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.). <br />5. I understand that statements in the application aze being made under penalty of perjury and that false statements made herein <br />aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS 1984. <br />Signed and dated this ~~~ day of-~(1 n P/ ~.~~ <br />~6~~ s. sCO-~ <br />ApplicandOperator <br />Signed: _ .~'~~ ~C~ <br />Title: /~ Gl /Y.'Q~ ~ ,.• -Pn /,v.~~7 <br />State of( SJI~rLZ.C1lJ ) <br />n.,. ) ss. <br />County of ~T ~~ f Q ) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this ~ day of ~ r , ~, by <br />as <br />of <br />(tp Opb, <br />~ d~ <br />J ~ otl -' Public <br />o m <br />Z QJ ~o My Commission expires: l '~ 7 ~~OD }~ <br />SIGNATURES IViUST BE IN BLUE INK <br />If Corporation Attest (Seal) <br />Signed: <br />M:~MIMSHP.RE\VSFORMS\282ICOIO.MP 06/25/99 <br />