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Certification: <br />-6- <br />As an authof~zed repzesentative of the applicant, I hereby certify that the operation describedhas met theminimum requiretJients of <br />the following terms and conditions: <br />A.ll necessary approvals from local government have been applied for (Section 34-32.5-110(lxa)(VIII). <br />2. To the best of my lmowledge, all significant, valuable and permanent man-made stcuchne(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 34-32.5-115(4)(e), C.RS.). (NOTE: For 110 operations, the affected area includes all lands delineated by the <br />permit boundary.) <br />3. 1`to mining operation wi11 be located on lands where such operations are prohibited bylaw (Section 34-32.5-115(4xf), <br />C.RS.). <br />4. As the applicanUoperator, I do not have a~ mining/exploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials <br />(Section 34-32.5-120, C.RS.). <br />5. I understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. 1984. <br />17iisformlxas been approvedbY theMmedLandRedamation Board pursuartttosedion3¢32S-IIO,GRS, oftheColorado <br />Land ReclamationAdfortheExtractionojConslructionMaterials. Any alteration ormodrficationofthisformsha!lr~csuh <br />in voiding any permit issued on the altered or mod~d form and suhjecY the operator 1o cease and desisd orders and Civil <br />penalties fi>r operating without a permit pursuant to secxion 34-32-123, GRS <br />Signed and dated this day of ~SeoY~ ~G~~ <br />ApplicanUOperator <br />Signed/ ~ Chxr~TA.rci~~ <br />If Corporation Attest (Seal) - <br />Signed: ~ nn 1f; ),~.o <br />Corporate Secretary or Equivalent <br />Title: _ 4%~r°_ l'J~t//il/~i" Town/City/ oun Clerk ' <br />State of C ~~>sLC~w 1 <br />) ss. <br />County of l`oS7~.~!/.~ <br />The foregoing instnmlent was acknowledged before me this day of ~ ~P~ ~ Gl~~ ~`f <br />by ~(el a~n ~ Coe.`~i l vex a. as ~l1ey of~i i i,~ra`s fi(~ta.Ya-Fiona . <br />ANNETTE CARI~O ` ~ ~f ~'LV11t~ <br />NOTARY PUBLIC Notary Public <br />STATE OF COLORAC)O <br />PAYOONMISSION EXF'iRE312.05-08 My Commission expires: ~ ~ <br />SIGNATURES MUST BE IN BLUE INK <br />M:~xnin\vfiare\,sfmma\Construc[ion110 (07/28/2004) <br />