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- 6 - <br />Certification: <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 necessazy approvals from local government have been applied for (Section 34-32.5-110(1)(a)(viii). <br />2. To the best of my knowledge, all significant, 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 (Section 34-32.5- <br />115(4)(e), C.R.S J. (NOTE: For 110 operations, the affected azea includes all lands delineated by the permit boundary.) <br />No mhilng operation will be located on lands where such operations are prohibited bylaw (Section 34-32.5-115(4)(f), C.R.S.). <br />4. As the applicantloperator, I do not have any mining/prospecting 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 aze being made under penalty of perjury and that false statements made herein <br />are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S 1984. <br />Signed and dated this 12' day of XPRIL <br />James R. Schauer <br />ApplicanUOperator f~ <br />Signed: `~~~ 1\ ~ ~ "~~~~~ <br />Title: Chairman <br />Sta[eof Colorado ~ <br />ss. <br />County of Fremont 1 <br />The foregoing instrument was acknowledged before me this 12 <br />James R. Schauer aS Chairman <br />~oiEylCounty Clerk <br />day of April 2002 by <br />of Fremont County <br />o ary Public V <br />My Commission expires: 7' ^ 6 la~~ <br />SIGNATURES MUST BE IN BLUE INK <br />2002 <br />If Corporation Attest (Seal) <br />Sign :' <br />Corporate Secret or Equivalent <br />M:~IdINISHARE\VSFORMS12821CO10.APP 10/I S/Ol <br />