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<br />- 6 - <br />rtificatioa: - <br />As an authorized representative of the applicant, I hereby certify that the operation <br />described 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 34-32.5-110(1)(a)(viii). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made <br />structure(s) in existence at the time this application is filed, and located within 200 <br />feet of the proposed affected area have been identified in this application (Section 34- <br />32.5-115(4)(e). C.R.S.). (NOTE: For 110 operations, the affected area includes all lands <br />delineated by the permit boundary.) <br />3. No mining operation will be located on lands where such operations are prohibited by <br />law (Section 34-32.5-115(4)(£), C.R.S.). <br />4. As the applicant/operator, I do not have any mining/prospecting operations in the <br />State of Colorado currently in violation of the provisions of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, <br />C.R.S.). <br />5. I understand chat statements in the application are being made under penalty of <br />perjury and that false statements made herein are punishable as a Class 1 misdemeanor <br />pursuant to Section 18-8-503, C.R.S 1984. <br />Signed and dated this ~~ day of ~ it i..~.~ac._ _ B2 D <br />Stanley Rasmussen <br />Applicant/Operator <br />Signed: „C~t .J// • ~LCo-.«~^"^1~ <br />Title: SUperViSOr <br />State of Colorado ) <br />ss <br />County of Rio Blanco ) <br />The foregoing instrument was <br />by Stanley Rasmusse <br />'- ,, _ <br />,. ~` ^- <br />, _ - ;- <br />acknowledged before me this .Zd~" day of ~7o~-T~~. <br />n as Supervisor of and Br~dgeaDepar~men~ Road <br />If Corporation Attest (Seal) <br />Signed: ~'!*r~"SS ~ L~m~ <br />C~te Secretary or Equivalent <br />TownlCitylCounty Clerk <br />~~~ ~' _ <br />Notary Public <br />My Commission expires: //- $-200.3 <br />SIGM7~TIIRES MUST B8 IN HLIIE INR <br />OS/25/97 282 iFC0.110 <br />