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I <br />- 6 - <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br />following terms and conditions: <br />All necessary approvals Gom local government have been applied for (Section 34-32.5-110(l)(a)(viii). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made swcture(s) in existence at the time this <br />application is filed, and located within 200 feet of the proposed afTected area have been identified in this application <br />(Section 34-32.5-I i5(4)(e), C.R.S.). (NOTE: For l 10 operations, the affected area includes all lands delineated by the permit <br />boundary.) <br />3. No mining operation vvill be located on lands where such operations are prohibited by law (Section 34-32.5-1 l5(4)(f), C.R S.) <br />4. As the applicandoperator, I do not have any mining/prospecting operations in the State of Colorado currently m violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Conswction Materials (Section 34-32.5-120, C.R.S.). <br />5. I understand thaz statements in the application aze being made under penalty of perjury and that false statements made herein <br />are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS 1984. <br />Signed and dated this ~_ day of J.~~// i1 G~ `~ , ~L~~. <br />ApplicandOperator <br />Signed:/ ~G,~/I/~y ~- <br />Title: 2G/~O °F ~~lDlo~ ~u®E7'~I//SO.Q <br />State of ) <br />~ ) ss. <br />Counp~ of <br />as Las Animas County Clerk. <br />The foregoing instrument was acknowledged before me this 12th day of January 2001 b~- <br />Phil Dorenkamp as Road & Bridge Supervisor x~cand Bernard J. Gonzales <br />If Corporation Attest (Sea]) <br />Sign ~ ~/~- <br />Corporate Secretary or Equivalent <br />#ox9lCounty Clerk <br />Notan Publi <br />My Cotrtmission expires'. <br />12/7/04 <br />SIGNATURES MUST BE iN BLUE INK <br />M:U1IMSFL4RE\VBFORMS\282ICOIO.APP 06/25/99 <br />.,•, <br />18057 HVVY 12 <br />WESTON, CO 81091 <br />