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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 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 34-32.5-115(4)(f), <br />C.R.S.). <br /> <br />4. As the applicant/operator, I do not have any mininglexploration 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 ofperjury and that false statements made herein <br />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 MinedLand Reclamation Boardpursuant to section 34-32.5-110,C.RS., ofthe Colorado Land <br />Reclamation Act 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 modifred form and subject the operator to cease and desist orders and civil penalties for <br />operating without a permit pursuant to section 34-32.5-123, C.R.S. <br />Signed and dated this day of ?AV?' V a V p Q <br />1 l <br />Q I O t 0- Ut1.1^? ? ?. If Corporation Attest (Seal) <br />Applicant/Operator <br />>>?a ;a99T?,ipafpyg <br />Signed: - •ea ??.?' <br />i' <br />Signet: °m G <br />B <br />% <br />orporate Secretes ytluivalent ' o <br />Title: Towiv? it?County Clerk?? <br />Q F P © ,,,,,y : <br />State of <br />1?.f R ? Q z:Lb <br />) Sas. .r ?? i?Jt !'y0 QOM.. `?? <br />County of Hv471 N6Q <br />The foregoing instrument w s acknowledged. before me this (la of _._. ?J t'1l?LZ (? t <br />by as of Lic., <br />pop <br />--- - .L ??°?`'??-_- <br />JODI L. EASTHAM #ryblic <br />NOTARY PUBLIC STATE OF CO <br />l <br />LORADO on expires: 4:12-710 <br />Nly Commission Expires 0310612011 <br />SIGNATURES MUST BE IN BLUE INK