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-~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br />fallowing 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 structure(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 34-32.5-115(4)(e), C.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by the permit <br />boundary.) <br />3. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-1 l5(4)(f), <br />C.It.S,), <br />4. As the applicant/operator, l donot have any miningr`exploration operations in the State of Colorado currently i.n violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Constniction tilaterials (Section 34-32.5-120, C.R.S.). <br />5. I understand that statements in the application aee being made under penalty ofperjury and that false statements made herein <br />are punishable as a Ciass 1 misdemeanor pursuant to Section 1$-8-503, C.R.S. 1984. <br />This form has been approved by the ~~fined Land Reclamation Board pursuant to section 34-32. S-I I O,C.R.S., of the Colorado Land <br />Reclamation ftct for the Extraction of Construction Materials. Any alteration or modification of this form shall result in voiding <br />any permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties for <br />operating -vithout a permit pr~rsuant to section 34-32.5-123, C.RS: <br />2`~ <br />Signed and dated this ~1' ' day of ~ Ted 5.~ ~©O7 <br />L~~1~v9r/~l~dl /~iu ~mP~,ts y <br />Applicant/Operator <br />Signed: __T1 l/ ~~i~-- <br />Title: _ DPEQ/~TL~t3LS__~~.9l.E~F1~-____-- <br />State of . ~~_~~~'~_ti-(~__------_..~) <br />I SS. <br />County ot .-.~~...-__._._...----------------~ <br />If Corporation Attest (Seal) <br />A -_ <br />- ~^ J - ' <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/CityiCounty Clerk <br />'1'he faregoin~ instrctment was ack~iawledged. before rtse this _...._...„ ~r~_..._-_--- clay af .,.......,_,~~~ ..............._-....._,..,...................>.....5~~~.> <br />~U - <br />... _.. <br />PAY pVe~ ~,vozary ruoi~c <br />O ~1y Commission expires: <br />~~ <br />., BATES : ~ c:r:~-•t°Ire~:s ~ti„s~I• I;~.-1.~ ~r.:Y.~»: iwx. <br />~,9~ OF C0~'pQ~ <br />