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-7- <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 />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 pennanent 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 34-315-115(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 34-32.5-115(4)(0, <br />C.R.S.). <br />4. As the applicant/operator, I do not have any mining; exploration operations in the State of Colorado currently in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C..R.S.). <br />5. I understand that statements in the application are being made under penalty ofper ury and that false statements made herein <br />are punishable as a Class I misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />Thisform has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-110,C:RS., ofthe Colorado Land <br />Reclamation Act for the Extraction of Construction tVaterials. 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 />Q? operating without a permit pursuant to section 34-32.5-123, C.A.S. <br />Signed and dated this day of \ C) T ' <br />C I <br />Q l o r,-Ao GUL'Cr ,LLB. <br />Applicant/Operator 7- <br />/ O 14' ? t ? r ? `''?S <br />_? •' i lti r <br />Signed: "', <br />Signe <br />- orporate Secretal„y 441livalent r <br />Title. Town/4 itiJjCounty Cletk`4; Q <br />State of <br />f" e <br />) ss. r°s W -. ; gam`?v ' ono. <br />County of <br />a ?Yaiy. ? ` S?bpq?a a <br />The foregoing instrument w s acknowledged before the this day of ( <br />by as of? L. <br />JODI L. =EASTHAM <br />? ry l;£ <br />J NOT <br />AR? ? STATE OF h onunission. expires: <br />MY COMMission Expires 0310612011 <br />SIGNATUW,S MUST BE I;Y BIXE INK