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NOV g 9~ 2001 DEC 3.1 ~ <br />Certification: Divisiaa pf AAiparpls aad Gaplpgy Gaol <br />. ~:: ~Yliaarals and p8Y <br />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 />1. All necessary approvals from local government have been applied for (Section 34-32.5-110(1)(a)(viii). <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 azea have been identified in this application (Section 34-32.5- <br />115(4)(e), C.R.S J. (NOTE: For 110 operations, the affected azea includes all lands delineated by the permit boundary.) <br />3. No mining operafion will be located on lands where such operations are prohibited by law (Section 34-32.5-115(4)(f), C.R.S J. <br />4. As the applicant/operator, I do not have any mining/prospecting operations in [he State of Colorado currently in violation of <br />[he prorisions of the Colorado Land Reclamation Act for the Extraction of Construction ifaterials (Section 34-32.5-120, C.R.S J. <br />5. I understand that statements in the application aze being made under penalty of perjury and that false statements made herein <br />aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S 1984. <br />Signed and dated this 2.(o day of N d ~_ /11 ~iP 2Gt7 / _ y <br />~': <br />~~ LOuKOn1E~J p~5. 5iaf1E CO. <br />ApplicandOperator <br />signed: ~~i~~ <br />Title: G.EnI~iPAL iy1A./~tGFiP / /~ <br />State of C.D~Or C-~ O ) <br />County of ~ t1~ ~~ (`a ~.Y' ) <br />j. <br />If Corporation Attest (Seal), '~ 1 <br />y~ <br />~.; <br />signed( / ~~' ~~_,~JF~~ <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrume <br />t was acknowledged before me this a ~ <br />n day of ~ ~V • , ~_, by <br />~ <br />ee <br />'~\~ e. "4~0\\~>`~\~A?f1 as ~Se~ eY C'~ C~ ~Q6 e C of ~~ b\ ©~~ ~. <br /> <br />- • ;~v _. <br />.- <br />':;., ~ . <br />. , .. <br />~. ~~!`~L <br />Notaz Public <br />My Commission expires: ~19Eu~s€eb. 5, 2005 <br />SIGNATURES MUST BE IN BLUE INK <br />M:\MIMSHARE\V SFORMS\2821CO10.APP 10/15/Ol <br />