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-~- <br />Certlficatioa: <br />As an sutlwrizedrepresentative ofdu applicant l hereby cetriCy that tbe operation described has and the ®ai~ast requiremetns of the <br />folbw'vtg tercets :mil coaditiom: <br />1. All necessary approvals Cram local government have bern applied for (Section 34J2.5-110(1 xaxV III). <br />2. To iLrt best of my lmowkdge, all sigaificartt, vahgble aril permarteot mao-made struchne(s) in existence at the time Otis <br />application is 61ed, a~ located witbm 200 feet of the proposed affected area have been identified in flris application <br />(Section 3AI-32.5-115(4xe), C.RS.). (N07'E: For 110 operations, dte affected area inchsdes atl hods delineated by the pemrit <br />bournlary.) <br />3. No arinsg operation will be located on lands where such operation are prdttbiced by law (Section 34325-115(4xf), <br />C.R.S.). <br />4. As the appGcant/operator, I do riot have any mining/explnration operation in the State ofColmado currently in violation of <br />the provisic~ of[be Colorado land Reclamation Act for the Extraction ofContructiorr Materials (Section #32.5-120, C.RS.). <br />5. I u~erstartd that statements m tbe application are being rrmde miler pemlryofperjuryand that false state~neots ttrde heteio <br />arc punishable ss a Class 1 misdemeanor puts»aat to Section 18-8-503, C.RS. 1984. <br />77YLsjoewe has bone approard b)tbebffaedLend Reelaatalfon doord pwrswawt ro secelow 31-325-/10,C.RS, ojdYtCoforado Land <br />Rtclemaliow Acs jarrlYe P.rdivdiew ojCotesrrrcafow Mererlals My aheraNow or wrodlfkatiwn ajtbisjonu shall reswUW valding <br />ony psrarh iaswed ow the a4ered or weoaUJled jour owl swbpu the operarer to cease and dearer orders anal elWl pardNea jor <br />operaAiag wLbore a perwB pwrswawt ro aev.7iow 3<325-723, CRS <br />Signed and dated this _l ~--Y day o'er rfl rn u,C)/l~Ll~ ~~ 1 ! t <br />if Corporation Attest (Seal) <br />Signed: <br />l~J~¢~t^-^~ <br />Title:.. ~ ~ C F i f~ <br />County of ~..~,Y l ~~y l,(') ~ ) ~ <br />TowNCity/Couaty Clerk . <br />~ ~ I <br />ilte C mg atsntnrxttt was ackmwledged before m~e ~t~is,_, _7,~_-(~~~~,___, day o , <br />yz_ ..~_~.r~ <br />Signed: ~~ <br />Corporate Secretary or Egirivaleat <br />~~~~~~ <br />Notary public ~-7 ~ <br />My Corr~ission e.~ires: ti~ ~ 1 1, <br />SICtiAT17RES MLrST BE IN BLUE INK <br />M:Mnin'shadvsrmms.(',mUnnrionl In (Atgaoued OY'i Ii200s) <br />