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- 6 - <br />Certification: <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)(f), 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 that 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 9~ <br />Title: <br />State of Colorado ) <br />ss <br />County of Phillips ) <br />rporation Attest (Seal) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />~ ~ G, QQ <br />The f/o~regoing instrument was acknowledged bef/o'~re me this ~ ~ day ofM ~9~0, <br />by (/Y ~~~a~/ as /,~/i//7ei'~ l/,OP.t~~CN of _ y.~/{2?!k// ~~~G'-/-(~f'.~~ <br />= -^~~ <br />iii r i _ <br />09/25/97 2821FC0. 110 <br />Notary Publi <br />My Commission expires: /D////~ 9 <br />SIGNATIIAES MAST HE IN BLIIE IHIC ~ <br />RE~EIV~D <br />uUG 2 (, 1998 <br />Division c! r1.~}•,~,a~s <br />8 Deplc,~~ <br />