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- 6 - 11 <br /> certification: <br /> As an authorized representative of the applicant, I hereby certify that the operation <br /> described has met the minimum requirements of the following terms and conditions: <br /> 1. All necessary approvals from local government have been applied for <br /> (Section 34-32 .5-110 (1) (a) (viii) . <br /> 2. To the best of my knowledge, all significant, valuable and permanent man-made <br /> structure(s) in existence at the time this application is filed, and located within 200 <br /> feet of the proposed affected area have been identified in this application (Section 34- <br /> 32.5-115 (4) (e) , C.R.S. ) . (NOTE: For 110 operations, the affected area includes all lands <br /> delineated by the permit boundary. ) <br /> 3 . No mining operation will be located on lands where such operations are prohibited by <br /> law (Section 34-32 .5-115 (4) (f) , C.R.S. ) . <br /> 4. As the applicant/operator, I do not have any mining/prospecting operations in the <br /> State of Colorado currently in violation of the provisions of the Colorado Land <br /> Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, <br /> C.R.S. ) . <br /> 5. I understand that statements in the application are being made under penalty of <br /> perjury and that false statements made herein are punishable as a Class 1 misdemeanor <br /> pursuant to Section 18-8-503, C.R.S 1984. <br /> Signed and dated this day of - <br /> Washington � Piatrirt 9 Rnad Dept If Corporation Attest. (seal) <br /> Applicant/Operator � - <br /> Signed: � Signed: { _ZacYOAAN <br /> ^Corporate Secretary or Equivalent <br /> Title: PorPman of Dict 21, Road Town/City/County Clerk <br /> State of Colorado ) <br /> ss <br /> County of Wachingtnn ) <br /> The foregoing instrument was acknowledged beforeef me this day/ of �, / L l <br /> by 1.(�i /, as e1 ,Z l�-t II��(�ttZG�._ of J / <br /> -Not-C& Public <br /> rQ� My Commission expires: <br /> S Au r V-\EJ# <br /> l�rFOF C6t SIGNATURES MUST HE IN BLUE INK <br /> 04/25/97 2821FCO.110 <br />