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- 6 - <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br />following terms and wnditions: <br />1. All necessazy approvals from local government have been applied for (Section 34-32.5-] 10(1)(a)(viii). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time this <br />application is filed, and located within 200 feet of the proposed affected azea have been identified in this application (Section 34-32.5- <br />I15(4)(e), C.R.S J. (NOTE: For 110 operations, the affected azea includes all lands delineated by the permit boundary) <br />3. No mining operation will be located on lands where such operations are prohibited bylaw (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 State of Colorado currently in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S J. <br />5. I understand that statements in the application aze being made under penalty of perjury and that false statements made herein <br />aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S 1984. <br />Signed and dated this ~~ day of ~ ~/ oC ~ OeZ <br />Anthony A. Blasi <br />Applicant/Operator <br />Signed: G2;A14m-~ ~ G,1~..` ~?~> <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Title: President <br />Town/City/County Clerk <br />State of Colorado <br />uerfano ) ss. <br />County of ~ ) <br />The foregoing instrument was acknowledged before me this _ U ~y_ day of 1111 , by <br />.~'}1 k ~r . g ~ !~S! as P\f'C~J i '~ h~- fF• g % P5~ .t 6 r~ <br />ofr y- ~i6 Y i no. .P £R r+l. moyr~,~ <br />~- ~ <br />f~ (~~ Vl c~~- <br />Notary Pub is <br />MyCormnissionexpires: ~~~ /`[~IO <br />SIGNATURES MUST BE IN BLUE INK <br />M:\IvIIN~SHARE\VSFORMS\2821CO10.APP ]0/15/01 <br />