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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 ruirrirrnnrr requirements of <br />the following terms and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-I 10(1)(a)(viii). <br />2. To the best of my lmowledge, all significant, valuable and pennanentman-made structrne(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 <br />(Section 34-32.5-115(4)(e), C.RSJ. (NOTE: For 110 operations, the affected area includes all lands delineated by the <br />permit boundary.) <br />3. No mining operation will be located on -ands where such operations are prohibited bylaw (Section 34-32.5-I 15(4)(f), <br />C.RSJ. <br />4. As the applicant/operator, I do not have arty mining/prospecting 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 aze being made under penalty of perjury and that false statements made <br />herein are punishable as a Class I misdemeanor pursuant to Section 18-5-503, C.R.S. 1984. <br />Signed and dated this 15th ~yof August 2005 <br />Weld County Board of Commissioners <br />Applicant/Operator <br />~ / <br />Signed: r ~l~' <br />Title: Chair, William H. Jerke <br />State of Colorado <br />County of Weld <br />ss. <br />The foregoing instrument was aclmowledged before me this 15th day of <br />William H. Jerke as <br />of <br />Public <br />My Commission expires: <br />oration Atte~~~'//~G~ <br />Corporate Secretary or Equivalent <br />Ci /Coun~~~~ <br />SHARON <br />KAHL <br />rs <br />2006 <br />SIGNATURES MUST BE IN BLUE INK <br />M:\min\shaze\vsfortns\Corstrudiort110 (05/06Y2003) <br />