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<br /> <br />-6- <br />Certifications <br />As an authorized representative of the applicant, I hereby certify that the operation described <br />has met the minimum requirements of the following terms and conditions: <br />1. All necessary approvals from local government have been applied for <br />(Section 34-32.5-13O(1)(a)(viii). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) <br />in existence at the time this application is filed, and located within 200 feet of the <br />proposed affected area have been identified in this application (Section 34-32.5-115(4)(e), <br />C.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by the <br />permit boundary.) <br />3. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-115(4)(t), C.R. S.). <br />4. As the applicant/operator, I do not have any mining/prospecting operations in the State <br />of Colorado currently in violation of the provisions of the Colorado Land Reclamation Act for <br />the Extraction of Construction Hateriale (Section 34-32.5-120, C.R.S.). <br />5. I understand that statements in the application are being made under penalty of perjury <br />and that false statements made herein are punishable as a Claee 1 misdemeanor pursuant to <br />Section 18-8-503, C.R.S 1984. <br />Signed and dated this ~~ day of ' ~. <br />~?Q ) <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secrets or quivalent <br />Town/City/County Clerk <br />The foregoing instrument wra/s~ acknowl~e~dged before~~m~e `this ~ da'y~nof 1/-_r;_ ~~, ~..,t- <br />by ~ ~O ~° I~OCh P~tt ~s (//C,~ ~.a.~C.~i'~ of //IBC[ n /A Q.~,-. ~l~lK WA <br />Notary ublie <br />My Commission expires: ~ ~~~~ <br />01/02/96 2ffiIFCO.110 <br />~~ ~}~` <br />State of ~ /~A'(~(IfI U ) <br />99 <br />County of ) <br />