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<br /> <br /> <br />- 6 - <br />~erti6cation: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br />following terms and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-1 10(1)(axviii). <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 iden[ified in this application <br />(Section 34-32.5-1 15(4xe), C.R.S.). (NOTE: For ] 10 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 are prohibited by law (Section 34-32.5-] 15(4x1), C.R.S.). <br />4. As the applicanUoperator, I do not have any mining/prospectingopercttions in the State of Colorado currently in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.RS.). <br />S, I understand that statements in the application are being made under penalty of perjury and that false statements made herein <br />are punishable as a Class ]misdemeanor pursuant to Section 18-8-503, C.R.S 1984. <br />Signed and dated this ~ ~ day of C('t/ ~ , __(__L. <br />~~~ <br />ApplicanUOperator <br />Signed: ,C%~2%'-~~' <br />Title: OtuNaA / S ¢-C. i EirtOLyY~d1 <br />If Corporation Attest (Seal) <br />Siged: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of ~ ~b('Ct ~O ) <br />I ss. <br />County of ~tt ~ deT ) <br />y+. <br />Th'e `foregroing instrument was acknowledged before me this z5 - day of 114-1 . by <br />NPl'-I~f ~ ('~kl~ as Oc.J/tE/- of ~it r0 Q~ <br />~'.•'~~• <br />~~:AvB~`,'.Q NotaryPubl' / <br />9TFOF COLOPP My Commission expires: / ' zq_ Zook <br />My Commission Expires 09/29/2002 SIGNATURES MUST BE IN BLUE INK <br />M:1MQJlSHARE\V SFORMS\?R2ICOIO.APP 02/10/99 <br />