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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 minimum <br />requirements of the following terms 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 knowledge, all significant, valuable and permanent tnan-made structure(s) in existence at the time <br />this application is filed, and located within 200 feet of the proposed affected azea have been identified in this application <br />(Section 34-32.5-115(4)(e), 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 aze prohibited by law (Section <br />34-32.5-I 15(4xf), C.R.S.). <br />4. As the applicant/opemtor, I do not have any 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.R.S.). <br />5. I understand that statements in the application are being made under penalty of perjury and that false statements <br />made herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />This farm has been approved 6y the Mined Land Reclamation Board pursuant to section 34-32.5-IIO,C.R.S., of the <br />Colorado Land ReclamationActfortheF-xtractionofConstructionMaterials. AnyalteraHanormodificationofthisform <br />shall result in voiding any permit issued on the altered or modifiedform and subject the operator to cease and desist orders <br />and civil penalties for operating without a permit pursuant to section 34-32-123, C.R.S. <br />Signed and dated this ~ 3T~- day of t~ ~'t~n ~OS <br />T <br />/~(Cf} rRoA GcC75 t I nJC . <br />Applicant/Operatfor n <br />Signed: ~~ L ~-tt~~ <br />Title: ~~i~?ri.Tr <br />If Corporation Attest (Seal) <br />Signed: Id4fto <br />Corp to Secretary or Equivalent <br />Town/City/County Clerk <br />State of ~©LD~f~DO ) <br />'/ ) ss. <br />County of ~ /1 A F~~~ ) <br />s~ The foregoing, i/nstrument was acknowledged before me this _ l~ day of ~~lf <br />cis Q~ _, by SYt~~Q~]~ ~~ ~ A .C~.e as C'Xt~'LU Tl CAF ~ DM. ~l S'T/~'Al'j of <br />7~•(~RD~GtC~S, 1 nfC <br />Notary Public / / <br />My Commission expires: ly r~lD ^ a~ <br />SIGNATURES MUST BE IN BL INK SHARON f~. CARR <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />My Commission Expirra >~i g/?007 <br />