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-7- <br />Certltieation: <br />As anauttmtized tepresentativt of the applicant, I herebycertify tbatthe operatiao described has met the minivan regldrerarnts ofthe <br />following terms and wnditions: <br />t. All accessary approvals from focal government bout been applied for (Sation 34-32.5-1 t0(1)(a)(VBl). <br />2. To the best of tm lawwledgc, all signiftfA„t' valuable and permacentman-made stmcnue(s) in exiatemx at the time tltis <br />applicaaan is Bled, and located widlin 21X1 feet of the propoud affected area have been identified in this application <br />(Section 34-32.5-115(4)(e), C.R.S.). (N07'E: For 110 oplratlonR the afftcted area inchtdes all lands delineated by the pemut <br />boundary.l <br />3. No mining operation will be located on lands where such operations ate prohibited by taw (Section 34-32.5-I15(gxfj, <br />C.R.S.). <br />4, Astheapplicant/operator,Idoaotbaveaoymining/explorstionoperationsintbe$tateofCobradocmremlyinviolafionof <br />the provisiore of the Colorado Lamt Ralamation Act for the FxtractionofConstruction Materials (Section 34-32.5 t20, C.RS.). <br />5. [understand that statements in the applicationgrebevlgmadeunderpenaltyofpetjmyandthatfalsestatetuemsmadeherein <br />arc punishable as a Class 1 misdemeanor pursuant to Section I8-8-503, C.R.S. 1984. <br />Thlsform has hten gpproved~by theMlaed Land Rtclamatiea Raard punaant to seefton 30-32.3-IIO,C 1P.S, ojthe Colorado Load <br />RaYamaNon Act jar the P.xmrcCloa ojConsfroatan Materfals. Aay alrcrotloa or modljkatioa a/this jorm skaR revuhin rold/ng <br />any penalt issued ea the altered or medlfltd jornt and sabjeM the operoror ro cease and desW orders gad clvR penahles for <br />operating tvlthout a penn& puraaaat ro aedfow 34-37.S~t1~3, C R.S <br />Signed and dated this / l day of <br />Signed: <br />Title: <br />Statc of crYt v~~ A.~~~1 <br />({ } ss. <br />County oC A) ~~ .q~ Ate,., ~_) <br />If Corporation Attest (Seal) <br />Signed: <br />Catporate Secremry or Equivalent <br />TowniCityiCounty Clerk <br />The foregoing in-stntrmlern~t~was a/c~y~t°p~edged before me this ~ ~+~ day of t,~ v~q _ ~ ~}~7 <br />by v7:~.-6.ri'~l as ~Fd~r of <br />~ . ~ fl. 5 tk/W C Rav>;~ <br />Sherty I'haroah - NOTgfri PUBUC ° - ` 11Y1 n.3" - <br />*IO[arypubiic l <br />County of STOte of <br />Albany I N/yoming My Cotrnmssion egtires: c LXp! <br />bMt Cattunaaon ~ek November --_ <br />SIGNATURES MUSE BR IN BLUE INK <br />M:~minWme\vafwmsN:u,struuin~ la (At~pwed as/11200~ <br />