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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 <br />the following terms and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-110(1)(a)(viii). <br />2. To the best of my lmowledge, all significant, valuable and peananent man-made strnctwe(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)(e), 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 bylaw (Section 34-32.5-115(4)(f), <br />C.RS.). <br />4. As the applicant/operator, I do not have azry mining/prospceting operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Constmction Materials <br />(Section 34-32.5-120, C.R.S.). <br />5. I understand that statements in the application are being made under penalty of pequry and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />Signed and dated this 14 day of December <br />Don Blake for Lincoln County <br />Applicanot/Operat~or <br />Signed: ~ /a.,` .t~S1„~ <br />2004 <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate <br />Tide: Land Use Adm. <br />State of Colorado ) <br />ss. <br />County of Lincoln ) <br />T1h~e foregoing instrument was aclmowledged/before me this <br />Uo~, ~~Lr~{C~ as h~~ <br />BARBARA J. TALLEY '. <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />My commission expires 05/09/2005 <br />Cl~ <br />of GI,JCO<,J (;pu,,~ y~ <br />s~~~ ~ /~ <br />Notary Public <br />My Commission expires: Q~. ~ ~-,~ 0 ®S <br />SIGNATURES MUST BE IN BLUE INK <br />M:\mmishate\vsfolms\COns4vaionll0 (05/06/2003) <br />