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<br />- 6 - <br />ertification: <br /> <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 from local government have been applied for (Section 34-32.5-110(1)(axviii). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made struMUre(s) in existence at the time this <br />application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-1 l5(4)(e), C.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by the permit <br />boundary.) <br />No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-115(4xf), C.R.S.). <br />4. As the applicant/operator, I do not have any mining/prospectingoparations in the State of Colorado currently in violation of <br />the provisions of the Colorado Land Reclamation Act for the ExUaction of Construction Materials (Section 34-32.5-120, C.RS.). <br />5, I understand that statements in the application are 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 l Y l ~c~LL-t 2 (`X`~ ~~ . <br />c ~ ~~~\L1.,1 ~S <br />ApplicanUOperator <br />Sign <br />Title: _Y~Q,~% v <br />If Corporation Attest (Seal) <br />Siged: <br />Corporate Secretary or Equivalent <br />State of ~~~O~J <br />Town/City/County Clerk <br />ss. <br />County of ) <br />The foregoing instrument was acknowledged before me this ~ ~ day of ~ 0~ d by <br />as ~r////7~G/~E~ /i+~GC~'IZCc~ of <br />u+~:,°,~ ~ Notary ublic <br />9r °• ~,B LAG: 'Qo <br />F OF OO~Oe'P My Commission expires: C~3 <br />.` _1 <br />~yCom..•r,!ssicnE>~ires07/28/2003 SIGNATURES MiIST BE IN BLUE INK <br />M:Vv1P1\SHARE\VSFORMS~2R21COl0.APP 02/10/99 <br />