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<br />-6- <br />Certification- <br /> <br />As an authorized representative of the applicant, I hereby certify that the operation described <br />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 beet of my knowledge, all significant, valuable and permanent man-made structure(s) <br />in existence at the time this application is filed, and located within 200 feet of the <br />proposed affected area have been identified in this application (Section 34-32.5-115(4)(e), <br />C.R.S.). (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 lands where such operations are prohibited by law <br />(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 State <br />of Colorado currently in violation of the provisions of the Colorado Land Reclamation Aet for <br />the Extraction of Constriction lSaterials (Section 34-32.5-120, C.R.S.). <br />5. I understand that statements in the application are being made under penalty of perjury <br />and that false statements made herein are punishable ae a Class 1 misdemeanor pursuant to <br />Section 18-8-503, C.R.S 1984. <br />Signed and dated this ~_ day of ~A.~... , 99g <br />GL ~ ~~ i <br />Applicant/ rator <br />Signed: C1 t_ f-l ~ °~~ . <br />Title: Ow.i ~i~Q-~ <br />If Corporation Attebt jSeal) _ <br />Signed- ` <br />Corporate Secret ^o Equivalent <br />Town/City ounty Clerk <br />State of Co~ar4d0 ) <br />/~ ) ss <br />County of CG9~Q ) <br />The foregoing instrument was acknowledged before me this f~ day of /~ Qrc~n , f,Q~~, <br />by G(e~l l-1. 6~Ileaos as Pres~deN.~ o~ad/ o~_~os lM4eo,~~~ .I~,E. <br />1UNH11b~pq~~~i`/'' <br />~uSH Wpj F. ~.,~ it ~~~ <br />~pTAR y'. % 1 'Not ~ Fublic <br />-Q-O~ Hy Commission expires: c2(~7~99 <br />'°UBL1~ <br />., PO\~~ <br />~RCnn '~Q: .O~ SIGlU1TORES HOST BS IN SLUE INR <br />O1/02/9G ffiL1FC0.110 <br />