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-~- <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 />fotlowing terms and conditions: <br />All necessary approvals from local government bade 6oen applied for (Section 34-32.5-I 10(1)(a)(VIII). <br />2. 'fo the best of my knowledge, all significant, valuable and permanent man-trade stmcture(s) inexistence at the time this <br />application is filed, and located within 200 fee[ of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(4)(e), C.R.S.}. (NOTE: Port 10 operations, the affected area includes all lands delineated by the permit <br />boundary.) <br />3. No mining operation will tie located on lands where such operations are prohibited by law (Section 34-32.5-115(4)(f), <br />C.R.SJ. <br />4. As the applicandoperator, I donor have any mining/exploration operations in the State of Colorado currently in violafion of <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Conshvction Materials (Section 34-32.5-120, C.RS J. <br />5. C understand that statements in the application are being made under penalty ofperjury and that false statetttents made herein <br />are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />Thls farm has been approved by theMined Land Reelamafion Raardpursuant to seaWn 34-32.S-llO,C.RS, ojthe Colorado Land <br />Reclamation Act jot the Extraction of Construction Materials. Any alteration or modification ojthis jorm shall result !tt voiding <br />qny perm!! issued on the altered or modified form and subject Ore operator to cease and desist orders and elv0 penalties for <br />operating without a perm7,t1pursuant to section 34-a32n.5-123, C.RS <br />Signed and dated this ~7 ~ day of V"' ~L~ ~~C <br />Slate of lC3t". ~ ) <br />) 6S. <br />County of <br />The fore oing instmment was acknowledged before me this ~th day of I ~ I Ll ~.d l7 ~ , <br />by ~-~ as Pu,bl 1 [? W~S~}' 1L..~ ~ r1°~~Y~ of <br />~L~ C i ty ~ ' f I `' ~ ~R`~_ P_ue, <br />~~ ~~in~n0 a mQ CQ ~ D Yl <br />~p~~ ~ Notary Public <br />MgppEN?.~ Y P V 1 ~ ~ l_ ~~ -- <br />M Cormnission ex fires: <br />S[GN~I' BE [N BLI7F, INK <br />M:lminlsharelvsfomulConswclionl t0 (AtryroveA 051!12005} ~v <br />f~(,L(~ / f ~ W Q/1 (LS' "{/i VQC ~ Corporate Secretary or Equivalent <br />Title: / Town/City/County Clerk <br />