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-6- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minim~ttn requirements <br />of the following terms and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-110(1)(a)(viii). <br />2. To the best of my knowledge, all significant, valuable and permanent man-made stmctwe(s) in existence at the time <br />this application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(4)(e), C.RS.). (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 bylaw (Section 34-32.5-115(4)(f), <br />C.RS.). <br />4. As the applicant/opetator, I do not have any mining/prospecting operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34- <br />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 <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />Signed and dated this day of <br />~fLLS f•. If Corporation Attest (Seal) <br />Signed: <br />Title: <br />State of ~~v~r~O ) <br />) SS. y}~..,3, qb ~ln <br />County of{~G)~ ~i mc.> j ) <br />The foregoing instrument was acknowledged before me this V ~ day of _ <br />.~0.~~_S~cw Cc~,.clh as4x-;en~~;ye of <br />~,- -+~-'.-+s- (/~`~/lam <br />~ ./l <br />_ ~v :i <br />- ~'~ ~-. - <br />t <br />- -~ _ = i ~.- ~ b <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />~~ <br />J <br />------~ `-'~'.,~~ My Commission expires: 'S `~~OL~'j <br />`A <br />SIGNATURES MiJST BE IN BLUE INK <br />nt~~n~ogroros~cws~a~~uo «onsizooi~ <br />