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-G- <br />Certification. <br />As an authorized representative of the applicant. l hereby certifi that the operation described has met the minimum requirements <br />of the followine terms and conditions: <br />.411 necessan approvals from local government have been applied for (Section 34-32.5-I 10(1)(a)(viii). <br />2 To the best of me knowledge, all significant. valuable and permanent man-made sweture(s) in existence at the time <br />this application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 3d-32.5-1 IS(4)(e), C.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by the <br />permit boundan•.) <br />3. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-I li(4)(f), <br />C.R.S.). <br />4. As L4c applicanUoperator, I do not have any mining/prospecting operations in the State of Colorado clurentk in <br />violation of the provisions of the Colorado Land Reclamation Act for the E.~ctraction of Construction Materials (Section 34- <br />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 />~ ~u C.~. l .~ ~D <br />Signed and dated this day of ,,,••' , - <br />~, <br />;•,;. ~, <br />*• 'q -~ : G <br />n C ~ ~,~ L+.J ~iP, <br />>4 ~ ~~ r J~ w ~ ~ I fw~lw~ a~~ ~u ~/~ .Ltrc . If Corporation ~t4~t ~Sea1~ ~: P <br />ApplicanVOperator ~~'•• ' ' " <br />~ '1 <br />Signed: <br />Title: ~w~>r <br />h ":~:_ <br />Sigted: •~ ~~~ 1 , <br />Corporate Secretary or Equivalent <br />Tovvn/City/County Clerk <br />State of Go~6f~r,~i ) <br />p/ ~~ ss. <br />County of ~. 1--I--t 4 ) <br />The foregoing inswment was ackrtowledged before me th <br />as ~/~e/- <br />t4 <br />day of <br />,1 ~1~0 , b~ <br />_ of <br />,rr pOBLt~ ~ g <br />%, ~~ 1 ij F 0 n ~ ~ i ,~ P ~~ e <br />Notary Public <br />MY COMMISSION EXPIRES: <br />March 8, 2004 ~t ,/ _ ~ ll <br />My Conunission expires: d (9 <br />SIGNATURES MUST BE 1N BLUE INK <br />AI.'mvm'shuNVSfavc)2d21COl0APP (07~17iI000) <br />