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02/11/2002 18:4 <br />Certification: <br />- 6 - <br />RFCEI~IED 8Y FAlt <br />SEP 1'- ~~a <br />~__:~ <br />~ 08 <br />AS an authorized reprrsentative of the applicant. I herby terrify Thal the operation described has met the Minimum requirements of the <br />following terms and conditions: <br />1. All necessary approvals from local government have been applied for (SeUion 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 existcace a! the time thi: <br />application is filed, and located within 200 fen of the proposed affe~xed area Lave btrn idenLificd in this application (Section 34-32.5 <br />115(4)(e), C.R.S.). (NOTE: Far 110 operations, the affected azea includes all lands delineated by the permit boundary.) <br />3. No mining operation will be located on lands where such operations ate prohibited bylaw (Sectial 34-32,5-115(4)(f), C.RS.) <br />4. As tLe applieandoperator, i donor Lave any min(t4a,/prospecting operations in the Stale of Colorado currently in violation o <br />the provisions of the Colorado land Reclamation Act far the Extraction of Construction Materials (Seuion 34-32.5-120, CRS.) <br />1 <br />5. I tltldersland that statements in the application are being toade under penalty of perjury and that false sttttemr8ts made hunt <br />arc punishable as a Class 1 misdetncanor ptusuant [o Scdian 18-8-503. C.R.S 1984. <br />Signed and dated this ~ ~ ~ day of ~~/3/lk Amt ~"""~-- <br />(~l N! ~ 2K S 4l /~~ S~nd ~t~R,6s/r~.l t c <br />~J<1i'21 « /116,4/ f O'/LSt~'D~+-~ <br />ApplicanUQperator <br />Signed:d a...~,:.P,! ~./,rwn <br />Title: /1 P S i Q fin?' <br />Stare of ~t/~(1,AD ~ 1 <br />ss. <br />county of G'L,d„~ <br />The foregoing instrumrat was aclmowledged before toe <br />.2 as I <br />b'TAIE OFOF WEVA~A <br />Cau~ty Of Clark <br />ROBERT & WYATT <br />rct+c-+e. s~stosz-t <br />yya.e~thoR u mot <br />u Corporation Anent (seal) <br />Signed: <br />Corporate Secretary or 'valent <br />Town/City/Coutuy Geak <br />~/ ~ day of <br />of <br />b: <br />.L'nc . <br />My Commission expires: . Z 2L d <br />SIGNATURFC MUST BE LN BLUE INK <br />FA% 719 852 5058 WORDS PLUS <br />M:1t~RSHN2I:IVSFORM512831CO10.APP to/ISNI <br />