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Certification: <br />As an authorized representative of the applicant. I herebc_ cenify that the operation described has met the minimum requiremems <br />cf!`_~: f~!Ic~cr.s tzrms and condi!ions <br />All necessan approvals From local government hate been applied for (Section 34-325-1 10(1)(a)(ciii). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time <br />this application is filed. and ]ocated within 200 feet of the proposed affected aria have been identified in this application <br />(Section 34-32.E-I L~(4)(e), C.R.S.). (NOTE. For 1 l0 operations, the affected area includes all lands delineated by the <br />permit boundary.) <br />3. No atining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-11~(4)(f), <br />C.R.S.). <br />4. As the applicantloperator, I do not have any mining/prospecting operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34- <br />32.~-120, C.RS.). <br />~. I understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS 1984. <br />Signed and dated this ~ Sf day of S~O>~m6eV ZCbO <br />~ANiEL ~• ~C~tSS~CL <br />ApplicandOperator <br />Signed: ` <br />Signed: <br />If Corporation Attest (Seal) <br />Corporate Secretary or Equivalent <br />Title: ~r-c~~/L~~ <br />State of C'v Co,P~ ~ ) <br />ss. <br />County of ~`L/¢i'JZos/~ ) <br />The foregoing instrument was acknowledged before me this <br />as _ <br />%'A. U ~~ <br />U <br />~. <br />1 <br />/f a `~ <br />'~ t -o- I <br />n° r <br />~1,~'~ °UQLIG ~~ i% <br />ac~,~~,e...~.•.ro~,,,~~zazicoio.~rv coz~n,zouol <br />Town/CiR~/County Clerk <br />day of , b} <br />of Rs P.'T- <br />Not .Public p <br />My Commission expires: O "02~' ~'~~a- <br />SIGNATURES MUST BE IN BLUE INK <br />