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-~- <br />Certification: <br />As an authoriicd representative of the applicant, I hereby certify that the operation described has met the minimum requirements ofthe <br />following terms and conditions: <br />X111 necessary approvals from local government have been applied for (Section 34-32.5-1 ] 0(])(a)(VllI). <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 area have been identified in this application <br />(Section 34-32.5-1 [ 5(4)(e), C.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by [he permit <br />boundmy.) <br />3. Ko mining operation will be located on lands where such operations aze prohibited by law (Section 34-32.5-115(4)(t), <br />C.R.S.;. <br />4. As the applicanUoperator, I do not have any mining/exploration operations in the State ofColorado currently in violation of <br />the provisions ofthe Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-I20, C.R.S.). <br />5. I understand that statements in [he application are being made under penalty ofperjury and [hat false smtements made herein <br />are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />Thisjorm hn.c been npproverf by the Mined Land Reclamation Board pursuant to secdon 34-32.5-IIO,C.R.S, ojthe Colorado Land <br />Reclamation ; I ct for the Extraction ojConstraction Materials. Any alteration or modificntion ojthis jorm shad result in voiding any <br />permit issrr<~~/ orr the altered ar modifred jorm and subject the operator ro cease and desist orders and civil penalties jor operating <br />without n prrmir pursuant to section 34-32.5-113, C.R.S. <br />Signed and d.~(ed this ~~ day of ~~ac.f e2QXo <br />~iT ('~J5t~~1 ('four, ~`~ <br />A pelican Aerator <br />Signed: <br />Title: ~1~[Lt1t M IR1Jt ~ f) ~:~_ <br />If Corporation Attest (Seal) <br />•''~~ pN CO ~' %/ L ~~l <br />,,GP~,s ..~~~i c ePe, ~ <br />Y ~ ~•~t Cyr~ota[e Secretary or Equivalent <br />i S`FjC~' F Town/Ci ounty Cler <br />*~. <br />' ti ~•~ ' - <br />State of ~~~tl~D ) <br />ss. <br />Counryof ~1~( ~Ay25C'){J ) <br />.in <br />The foregoing instrument was acknowledge <br />Mme" 1. CAP 12SOtJ ~u-1~'ty <br />M:Min\shan\rsionns\Constmctionl [0 (Approved 05,.,,~.,,,~, <br />