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<br />Certification: <br />-6- <br />As an authorized representative of the applicant, I hereby certify that the operation described <br />has met the minimum requirements of the following terms sad conditions: <br />1. All necessary approvals from local govern~++t have bees applied for <br />(Section 34-32.5-110(1)(a)(viii). <br />2. To the best of my knowledge, all significant, valuable and pP*+~~eat man-made structure(s) <br />is existence at the time thin application is filed, sad located within 200 feet of the <br />proposed affected area have been identified in this application (Section 34-32.5-115(4)(e), <br />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 oa loads where such operations are prohibited by law <br />(Sedioa 34-32.5-115(4)(f), C.R.S. ). <br />4. As the applicant/operator, I do not have nay mining/prospecting operations in the State <br />of Colorado currently in violation of the provisions of the Colorado Land Reclamation Act for <br />the Extraction of Construction Naterials (Section 34-32.5-120, C.R.S. ). <br />5. I understand that statements is the application are being made under penalty of perjury <br />and that false statements made herein are punishable as a Class 1 misdemeanor pursuant to <br />Section 18-8-503, C.R.S 1984. <br />Signed and dated this ~~ day of / CJ/44r , ~ ~ ~O <br />Las / 7n/M QS (lO Un~`~ If Corporation Attest (sea1L <br />ic <br />ant <br />/ <br />Operat <br />or <br />App <br />l - <br /> / <br />~ <br />~/ <br />/f <br />~ <br />,~ <br />ff <br />` / ~ ///) <br />C <br />~ ~ <br />Signed: l~Gr~/ <br />~ <br />1 . <br />Llfrio Signed: I~_ <br />~_ - <br />n <br />~~ Corporate Secret or Equivalent <br />Title: (. d~ ~.~7y <br />Q nnPr ~w+a{C ity/County Clerk <br /> <br /> // <br />~O~Or400 <br />State of ) <br /> <br /> ) ss <br />County of ~.gs qn~~,{~ ) <br /> hi <br />~" d <br />f`y <br />C ~ <br />~ <br />The forego ing instrument w ay o <br />edged before me t <br />s <br />- <br />as acknowl , ~ <br />by <br />nhQ ~t - ~.~1 C2 /l <br />,1°o as ~/ a~,,,T/± ~ PLl)'/Vh¢ <br />le of 1 /~ S y <br />H//, 1'n/~t ~Ut/NfiY <br />p <br />°F Py R~IeN fl2D .5 <br />~, I <br />./ZR/e~- ~J ~e,Mt7CRC~ <br />I . <br /> <br /> Not Public <br /> Hy Commission expires: ~~~~ <br />- SIGRAIRRES MIIST BE IR SLiIE IIaC <br />oiloz/~ ~snFCOiio <br />FAYE CORDOVA <br />18050 HWY 12 <br />WESTON, CO 81091 <br />