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o EXHIBIT I o <br />-7- Instrum?nt l?aok F'cts~ <br />?iiCtgi~>.i1=;,~3.?,t_i OR 371 ?3S <br />As an authorized representative of the appl leant, I hereby certify that the operation described has met the minimum requirements of the <br />following terms and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-1 I0(l)(a)(VIII). <br />2. To the best of my knowledge, al l significant, valuable and permanent man-trade structure(s) in exisoetrce at the tune this <br />application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34.32.5-1 I5(4xe), C.R.S.}. (NOTE: Por t t0 operations, the affected area inchtdes all lands delineated by the permit <br />boundary.) <br />3. No mining oleration will be located on lands where such operations are prohibited by law (Section 34-32.5-115{4x.t}, <br />C.R.S.). <br />4. As the applicant/operator, I donot have any mitting/exploration operations in the State of Colorado cutxrntty in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction ofConstruction Materials (Section 34-32.5-120, C.RS.). <br />5. I understand that statements in the application are beittg trade under penalty of perjury and that false statements made herein <br />are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. 1984. <br />Thlsfarm has been approved by the M1ned LandReclamatian Board pursuant to section 34-32.S-I l O, C.RS., ofthe Colorado Land <br />Reclamation Act jor the.Extraction of Construction Materials. Any alteration or rnodi, flcation of this form shall result in -wWing <br />any permit Issued on tltr! altered or mod4fled form and subject the operator to cease and desist orders and civil penalties for <br />operating without a pernntit pursuant to section 34-32.S-I23, GRS ~/~'~ <br />Signed and dated this " l ~~ day of ©`\J <br />Applicant/Operator <br />T -~ <br />Signed' ~= __ <br />Title:~C,~.~~ ~ r~C.m~ ~~~~- <br />State <br />~ ) ss. <br />County of~~y/~~~,~_ ) <br />The foregoing ' t was acknowledg ore me this ~~ <br />o(D(J'(~ , by ~ r av1 <br />day <br />Corporate Secretary'~6i~gaiv;:z` <br />~'~.,To~'Cityi County, .C;Yerk <br />~~ <br />`c,..,. <br />of <br />~~ <br />„ Rt,,,J <br />t Otary ItC `y,~ try P f s .. JdQJ `, ;~.. <br />, 11 .t J~ <br />My Commission expos !~ ~~ ~~~ <br />SIGNATi1RF:S 1VIUST t3E IN BLUE INK a ~ ~ ~` ~"> <br />M:tministiarelvsfimnsfC,rn~stxvetionl f0 (Approved OS/I 1/2pp5) y ~`~, A ~ _~~ C. <br />fisr; d ... .. ~ ~~_. <br />A~•-~ <br />