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- 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 />1. All necessazy approvals from local government have been applied for (Section 34-32.5-110(1)(a)(viii). <br />2. To the best of my lmowtedge, 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 identified in this application (Section 34-32.5- <br />115(4)(e), C.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by the permit boundary) <br />3. No rrtining operaton will be located on lands where such operations aze prohibited by law (Section 34-32.5-115(4)(f), C.R.S J, <br />4. As the applicandoperator, I do not have any mining/prospecting operations in the Slate 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.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 />are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S 1984. <br />Signed and dated this ~ - ~~.~1,iday of ~~ ~ ~C~ G Z <br />1 1a. ~ ~l.J~ K~ <br />App[icanUOper~ato(r~ ~,, <br />Signed: II~ICYt ~ lltca~=~--- <br />If Corporation Attest (Seal) <br />Signed: <br />Title:~l PD`;~ <br />State of Ctn~o-rya,, ) <br />) 55. <br />County of ~a n c o~ ~, <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this Z~ day of ~zVa,-~ut.wt ~o o ~. , by <br />~s..~ ~1„k,. as ~v~c1 L~sz Aa,~,;,,,isa-,r,~-c1 of `-.:.,,c:,1,,. C'~,,~.~ <br />~~ <br />Notary Public <br />My Commission expires: ~-~~. ~~i-, coos <br />SIGNATURES MUST BE IN BLUE INK <br />M:N11NlSHARE\VSFORMS~2827CO10.APP 10/15/O] <br />