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RECEIVED <br />APR'i~ 22007 <br />Cerhfcahoa: <br />-~- <br />Division of Raelart1a11011, <br />Mining and Safely <br />As an authorized representative of the applicant, f hereby certify that tfie operation described has met the minimum requirements of the <br />foltowing terms and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-110(I)(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 <br />(Section 34-32.5-115(4)(e), C.R.S.). (NOTE: For 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 aze prohibited by law (Section 34-32.5-i 15(4)(1), <br />C.R.S.). <br />4. As the applicant/operator, I do not have any mining/exploration operations is the State of Colorado cmrendy 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 are being made under penalty ofperjury 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 />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-IJ O,C.RS, ofrhe Colorado Land <br />Reclamation Act far (he F,xtractian ojConstruction Ma[erurLs. Any alteration or modlfecation ojthis form shat/result trt voiding <br />any permit issaed on the ahered or modif7ed jorm and subject the operator to cease and d¢sist orders and ctvU penalties jor <br />operating without a permit pursuant to section 34-32.5-J23, C.RS. <br />Signed and daced this `~~ day of ~ R~ 11 Or~~ <br />~a~ ~eedl~ <br />Applicant/Operator <br />Signed• ~j <br />Title: DW~ <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />State of ~~t lAU'l~ ) <br />ss. <br />County of ~r('--t~'~QYI~ ~) <br />Town/City/County Clerk <br />'Che foregoing instmment was acknowledged before me this ~ l~ day of 1 1~ )1 \ l _.____ , <br />~~ by tS0.G~ ~~ as b(~1 Cl2f of <br />Jennifer <br />Rutfaik <br />Commission expires: ~~ it C ~~r ~~o~ <br />"'m'r. a, ~o zct)1 <br />;K:eicm aX{71168 <br />SIGNATURES MOST BF, IN BLUE [NK <br />M.~min`sharc`.vsfi,mutQmstructimil 10 (Appmv~d 0 5/1 112 00 5) <br />