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Certiflcatloo• <br />-6- <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of <br />the following temvs and conditions: <br />All necessary approvals from local government have bern applied for (Section 34-32.5-111(1)(a)(I?n); <br />2. This entire mining operation will not affect more than 30 acres; <br />3. This ruining operation will not adverselyaffect the stability ofany significant, valuableand pertnanrntman-made <br />structure(s) located within two hundred (200) feet ofthe affected lands. (However, where there is an agreement between the <br />applicanUoperatorandrhe persons having an interest in the structure that damage to the structure is to be compensated for <br />by the applicanUoperator (Section 34-32.5-1 IS(4)(e), C.R.S. 1984, as amended), then mining may occur within 200 feet <br />Proof of an agreement must be submitted to the Office prior to the decision date.) <br />4. No mining operation will be located oa lands where such operations are prohibited by law <br />(Section 3432.5-115(4xf), C.R.S. 1984, as amended); <br />5. As the applicanUoperator, I do not have any miniag/exploration operations in this state of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials <br />(Section 34-32.5-120, C.RS. 1984, as amended) as determined through a Board finding. <br />6. I understand that statements in the application are being made under penalty of perjury end that false statements <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. 1984, as amended. <br />This jorm has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-1I1,GRS, ojthe Co%rado <br />Lond Reclamation Act jorlhe Extraction ojConstruction Materraia Any alteration or modification ojthis form shall resulidw,,,, <br />voiding any permit issued on the altered or mod~d form and subject the operator to cease and desist orders and civlt penaltks <br />jor operating without a permit pursuant to section 34-32.5-123, C.RS <br />Signed and dated this G ~ ~s day of " ~/e /E~wv..~.. Zo.,,~ :,' `, - <br />~i <br />ApplicanUOperator <br />By. ~y ,~ ~?i//J.,i~ <br />Title: ~~' <br />Smte of ~ ()l_n IQI~I~(7 ) <br />ss. <br />Cauntyof >4n~/~Lrs ) <br />The foregoing inswment was acknowledged before me this _S_(~- day of <br />by~N~! ~f'1~tt4~~ClN as <br />If Corporation Attest <br />By: <br />SIGNATURES MUST BE ID] BLUE INK <br />. ~ s-~ 1. <br />± ~ , )" <br />+~. <br />m Equivalent <br />v Clerk <br />~: <br />/11 r <br />M:`.mircxlureWSlbme'Cartmretionl 1, (Approved OSi 1 I /2005) <br />My Commission expires: ~12~/~Q <br />