2007-11-28_PERMIT FILE - M2007067

• Permit No: M2007067
• IBM Index Class Name: PERMIT FILE
• Doc Date: 11/28/2007
• Doc Name: Completeness
• From: DRMS
• To: Cordilleran Compliance Services
• Media Type: D
• Archive: No

-7-
Certification:
As an authorl.zed representative of the applicant,l hereby certify that the operation described has met the minimum requirements of the
following terms and conditions:
1. All necessary approvals from local gavernment have been applied for (Section 34-32.5-110{ 1)(a)(VIII).
2. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time this
application is filed, and located within 200 feet of the proposed affected area have been identified in this application
(Section 34-32.5-115(4)(e), C.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by the permit
boundary.)
3. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-115(4)(f),
C.R.S,).
4. As the applicant/operator, .I do not have any mining/exploration operations in the State of Colorado currently in violation of
the provisions of the Colorado Land Reclatation Act for the Extraction of Construction tiiaterials (Section 34-32.5-120, C..R.S.).
5. I understand that statements in the application are being made under penalty ofperjury and that false statements made herein
are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. t
l~ ~~ ~~~~ ~~ ~~
ThisformhasbeenapprovedbytheMlnedLandReclamationBoardpursttanttosection34-32.5-1.10,CR.S.,of theColora~o anr! ~ ~ v,
Reclamation Act for the .Extraction of Construction Materials. Any alteration or modification of this form s/rail result in ia~ding ., , '?'
any permit issued on the altered or modified form and subject the operator to cease and desist orders and civil psrt~rlties;~ir ``" 'Y
operating without a permit pursuant to section 34-32.5-123, C RS: ° ~ ~ " ~ f
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Signed and dated this ~ day of D
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Applicant/Operator
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Signed• ~^~ i:' '~~+
Corporate Secretary or Equivalent
Title: _ DPI: lL!{T/bill S _ _~_,~_~~,~F~'{_______ Towiv'CityiCounty Clerk
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State of `~~~~L(~ _______ )
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2 ~ • ~ itity Commission. expires:
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