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-6- <br />Certification: <br />As an authorized representative of the applicant, I herelrv certifi that the operation described has met the minimum requirements <br />of [he follo~cing terms and conditions: <br />All necessary approvals from local gocemment have been applied for (Section 34-32.5-110(1)(a)(viii). <br />2. To the best of my lato+vledge, all significant, valuable and permanent man-made structure{s) in e`istence at the time <br />this application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-1 l5(4xe), C.RS.). (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 by law (Section 3432.5-115(4)(1), <br />C.RSJ. <br />4. As the applicanVoperator, 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 />32.5-120, C.RS.). <br />~. 1 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 ~___ day of Deceober <br />The Gallegos Corporation <br />ApplicanUOperator <br />Signed; <br />Title: G ~ ,~' <br />State of ~O~orado ) <br />ss. <br />County of ) <br />The foregoing instrument was acknowledged before me this <br />G~.~a)d 6. C lteoos as ~.~.o. <br />2000 <br />if Corporation Attest (Seal) <br />i <br />Sign ~: <br />Corporate Secretary or Equi ent <br />Town/City/County Clerk <br />19~~ day of ~¢c~wt~¢f ,by <br />of The Gallegos Corporation <br />~~~~ <br />Notary Public <br />My Commission expires: oZ~ 17(03 <br />MUST BE IN BLUE INK <br />