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Certification: <br />-6- <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimlml requvements of <br />the following temps and conditions: <br />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 lmowledge, all significant, valuable and permanent man-made structure(s) in eldsteJrce 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 34-32.5-I15(4)(e), C.RS J. (NOTE: For 110 operations, the affected area includes all lands delineated by the <br />permit boundary) <br />3. No mining operation wilt be iocated on lams where such operations are prohibited bylaw (Section 34-32.5-I IS(4j(f), <br />C.RS.). <br />4. As the applicanUoperator, I do not have a~ mining/exploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials <br />(Section 34-32.5-120, C.RS.). <br />5. I understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. 1984. <br />This form has been approved by the Mmed Laud Reclamation Board pursuant to sediwr 3¢32.5-110,CRS, of the Colorado <br />Land Reclamation Ad for the F.xtraclion ojConstrurxion Materials. Any alteration or modification ojthis form shall result <br />in voiding any permit issued on the altered or modified form and subject the operator to cease and desist orders and civil <br />penalties jor operating without a permit pursuant to serlion 331-123, CRS <br />Signed and dated this First day of November 2007 <br />ApplicanUOperator <br />Signed: lC,_,..~2~ 41~s~...,.os-.~-~~ <br />If Corporation Attest (Seal) <br />Signed: <br />Carpwate Secretary or Equivalent <br />Title:Land Use Administrator <br />State of ~lor..~ o ) <br />ss. <br />County of 1;r~\.. ) <br />Town/City/County Clerk <br />The fore`g'oing instrument was aclmowledged before me this ~~ day 1of fJ o..< w~1-~~ ~7 70-0']- , <br />by (Crw-~`~~. .~~+r so.._ ~ ~v.~1~15c ~a,-.mot nts~ailty of I..+v.c ul v. l_.6~n~ <br />~~. ~~ <br />Notary Public ~ <br />My Commission expires: ~~' - ~-y • 2 °O `I <br />SIGNATURES MUST BE IN BLUE INK. <br />M:4niu\sMrc\v~'omre\Construction110 (07/28Y2004) <br />