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Certification; <br />As an authorized representative of the applicant, I hereby certify that the operation descn'bed has met the <br />minimum requirements of the following terms and conditions: <br />1. All necessary approvals from local govmnment have been applied for (Section 3432.5- <br />110(1xaxVIII). <br />2. To the best of my knowledge, all significent, vahmbk and permanent man-made stnrcmre(s) in <br />existence at the time this application is filed, and located within 200 feet of the proposed atiecoed area <br />have been identified in this application (Section 3432.5-115(4xe~ C.RS.). (NOTE: For 110 <br />operations, the affected area inchrdes all lends delineated by the permit boundary.) <br />3. No mining operation will be lotxt~ on lands where such operations are prohibited by law (Section <br />3432.5-115(4xt), C.RS.). <br />4. As the appGcant/operator, I do not Gave airy mining/explotation operations in the State of Colorado <br />currently m violation of the provisions of the Colorado Land Reclamation Act for the F.xnaction of <br />Construction Materials (Section 3432.5-120, C.RS.). <br />5. I mderstand that statemems in the application aro being made under penalty of perjury and that <br />false statements made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, <br />C.RS. 1984. <br />Thla jorae h~ beex approved hY the riflxed Laid Rexlmeealiox Board patsrrmrt to serxiox 34-325- <br />110,C.RS, of tke Colorado Laid Rec/memtlort Ad jot tht i°.xbactlox of Coxsbactlox Moteria6. Any <br />alleraUox a remdJlextton of drtr forme shag resale ta rvoidheg axy perxeit hareed ox Oie altered or <br />modljiad jorm and srrbjact dte operator m case aced desist orders axd civil pexaUler for operaNxg <br />without a permit parsaaxt to seedox 34-325-123, CRS <br />Signed aad dated this ash day of f ~ U ~ u\ ,~Q( <br />/ /~~ v If Corporation Attest (Seal) <br />Signed: Sighed: <br />Corporate Seraetary or Equivalent <br />Title: nn 11 Town/City/County Clerk <br />State otL,t~lnflz~ ) <br />t---~ ) ss. <br />County of NY..ftlrK\~ ) <br />The foregoing' ent was acknowledg_~before the this o~5~= day of , <br />~O~ip ,by~.±n,~ " K.rdniK as of <br />Drury pu G <br />My Commission expires:~vne.c')t),dG107 <br />SIGNATURES MUST BE IN BLUE INK <br />(Ap~oved 05/112110.5) <br />t e~N AY/W i0e-t <br />