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7- <br />Certdication: <br />As an authorized representative of the applicant,! hereby certify that 0>e operation described has met the minimum requirements of the <br />following terms and conditions: <br />AlI necessary approvals from local governmr,ri have been applied fix (Section 34.32.5-I 10(1)(a)(Vltl) <br />2. To the best of my knowltxlge, all significant, valuable and permanent man-made structure(s) in existence at the time this <br />application is filed, and located within 200 fee[ of the propose) atTceted area have been idrntified in this application (Section 34-32.5- <br />1 15(4}(e), C.R.S.j. (NO"fE: For 110 operations, the affected erca includes all lends delineated by the permit boundary.) <br />3. No mining operation wilt be lacatcd on lands where such operations arc prohibited by law (.Section 34-32.5-I I5(4XQ, C.RS.). <br />4. As the applicart_Voperator, I do not have any mining/exploration operations in the Smte of Colorado currently in violationofthe <br />provisionK of the Colorado Land Rechmlation Act for the Extraction oCConstruction Materials (Section 34-32.5-I20, C.R.S.). <br />5. I understand that statements in the application are being made under penalty of perjury and that Celle alaternents made hetem ate <br />punishable as a Class 1 misdemeanor pursuant to Section I8-8-503, C.RS. t 984. <br />Tbisjorm bas beer approved by tbeMixed Lard Reclamation Board pursuant to sectiox 3i-32.5-IlO,GR,£, ojtheColarado Land <br />ReclamationAdjor tke Fxbacafar ojCnnatrucfion Materials. Any aberation or mndifuaa4rn ojtbisjorm shall reaultin rroidFrrgany <br />permit israed on the altered o~ madrfeed jorm and subject the operator to cease oxd desitl orders a»d civil penaGies jor operating <br />wi'Uiout a permit pursuant to steliox 3f 31.5-123, C.RS. <br />Signed end dated this ~ g ~ day of ~An, ue~ l U ,/tJW~ , <br />MS Forest, LLC. If CorporationAUest(Seal) <br />ApplicanUOper for <br />signed: _ ~ signed: ~c~t=A L <br />Corporate Secretary a Equivalent <br />'Title: President ~ Town(CitylCountyClcrk <br />Swteof Colorado <br />} ss. <br />Camtyof ~~/ ~yJ!/Y37G11 ) <br />"fhe foregoing instrument was acknowledged before me this ~ 1N ~ day of ~t'~U , <br />by Mary Shaw Cando as President of M F rest PLC. ' <br />Public <br />My Commission expires: <br />SIGNATURFS MUST BE IlV BLUE INK <br />lssion lixpires <br />cr 17 7!111(] <br />~,nnwbir'7r•. <br />G ~ :~ <br />M:~min~durc«sfortm\CaWruaionll0 (A{pro~'cd OSlt1/2005) ^M~c`'1`.Y ~ <br />e .~ <br />F~`~ ~~ <br />,, s• ~; <br />• `~`~.ttr--~ <br />°:d <br />`' ; Q <br />~' O <br />;`= - <br />... ~~ <br />..- <br />