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Certification: <br />-6- <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum <br />requirements 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 structure(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.R.S.). (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 by law (Section <br />34-32.5-115(4)(f), C.R.S.). <br />4. As the applicant/operator, I do not have any mining/exploration 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 <br />(Section 34-32.5-120, C.R.S.). <br />5. I understand that statements in the application are being made under penalty of perjury and that false statements <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-1111,CR.S, of the <br />Colorado Land Reclamation Actfor the Extraction of Construction Materials. An_v alteration or modification of this form <br />shall result in voiding any permit issued on the altered or modified form and subject the operator to cease and desist orders <br />and civil penalties for operating without a permit pursuant to section 34-32-123, C.R..S <br />Signed and dated this day of K. <br />CLG FARMS, LLC <br />If Corporation Attest (Seal) <br />Applicant/Operator <br />Signedzl? 4. Chester rbauer <br />Signed: <br />Corporate Secretary or Equivalent <br />Title: Manager <br />Town/City/County Clerk <br />State of COLORADO ) <br />) ss. <br />County of WASHINGTON <br />The foregoing instrument was acknowledged before me this day of A-1k 5+ , <br />9.?,b Kby CHESTER W_ GEBAL iER as MANAGER of <br />CLG FARMS, LLC , <br />KELLY S HANSEN <br />Notary Public Notary P 1 <br />State of Colorado <br />My Commission expires: <br />My Com, fftwlon E*&W <br />SIGNA'T'URES MUS'T' BE IN BLUE INK MW 20, 2010