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i RECEIVED <br /> -G - NOV 3 0 20M <br /> Certification: Division of Minerals and Geology <br /> As an authorized representative of the applicant,I hereby certify that the operation described has met the minimum requirements <br /> of the followine terms and conditions: <br /> 1. All necessary approvals from local government have been applied for(Section 34-32.5-110(I)(a)(viii). <br /> 2. To the best of my knowledge,all significant,valuable and permanent man-made structure(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 34-32.5-1 15(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 are prohibited by law(Section 34-32.5-115(4XD, <br /> C.R.S.). <br /> 4. As the applicant/operator, I do not have any mining/prospecting 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(Section 34- <br /> 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 s e <br /> herein are punishable as a Class I misdemeanor pursuant to Section 18-8-503, C.R_S 1984. <br /> Signed and dated this 13th day of November 2000 <br /> City of Walsenburg If Corporation <br /> Applicant/Operator J <br /> Signet / s �oCf�U t(9< SignJd__' ~ <br /> Fred A Rodriguez�— Corporate Secreta or Equivalent <br /> Title: Mayor Tewn/City/Gew+ty Clerk- <br /> State of Solorado ) <br /> ss. <br /> County of Rue rfano ) <br /> The foregoing instrument was acknowledged before me this 13th day of November 2000 b% <br /> Fred A Rodriguez as Mayor of the City of Walsenburg <br /> YLU <br /> Notary Public <br /> My Commission expire_� �a am <br /> SIGNATURES MUST BE IN BLUE INK <br /> F1:1mmkdwdW,f.1 t21COl0APP (07/1712000) <br />