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R o. • <br />- 6 - <br />Certification: <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 govemmrnt have been applied for (Section 34-32.5-110(1 xa)(viii). <br />2. To the best of my knowledge, all significant, valuable and permanrnt 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 identified in this application <br />(Section 34-32.S-I 15(4)(e), C.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by *.he permit <br />boundary.) <br />3. No mining operation will be located on lends where such operations are prohibited by law (Section 34-32.5-115(4)(f), C.RS.). <br />4. As the applicanUoperator, I do not have any mining/prospecting operations 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 />5, I understand that statemrnu in the application are being made under penalty of perjury and that false statements made herein <br />are punishable as a Class 1 misdemeanor plusuant to Section 18-8-503, C.RS 1984. <br />Signed and dazed this ~_ day of ~ -~ ,~~-. <br />If Corporation Attest (Seal) <br />Siged: <br />State of l ~/~ /C1 ~" (~ 1 <br />/~ / ) ss. <br />County of C CJ Ti /~C ) <br />The foregoing instrument was acknowledged before me this J` f h day of (~L/GT uS ~ . ~ f 9 cl - by <br />C' (rj / ~ <br />Corporate Secretary or Equivalrnt <br />Town/City/County Clerk <br />of <br />~ ~ , <br />Y (1~C _ <br />N tary Public <br />My Commission expires: <br />SIGNATURES MUST BE [N BLUE INK <br />M:1A1QJlSHARE\VSFORMS12621CUlU.APP OLIO/99 <br />F.VAN T._ MRi.RY. TNC. <br />