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-7- <br />Certification: <br />As an authorized representative ofthe 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 3432.5-110(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(4xf), <br />C.R.S.). <br />4. As the applicant/operator, I do not have any mining/exploration operations in the State of Colorado <br />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 of perjury 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 Mined Land Reclamation Board pursuant to section 34-32.5-110, GRS., of the Colorado Land <br />Reclamation Act for the Extraction of Construction Mwerlalx Any alteratlon or modification of this form shalt 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 without a permit pursuant to secdon 34-32.5-123, CRS. <br />Signed and dated this fh day of n u4 Q <br />?kavjyr L If Corporation Attest (Seal) <br />Applicant/Opemtor / <br />Signed: - Signed: <br />Corporf Secretary or Equivalent <br />Tide:_ t?S? ?Cxs ?Q_YYI ( Town/City/County Clerk <br />State of ool radn } <br />) ss. <br />County of ki iL (?lI5 O/1 1 <br />The foregoing instrument was acknowledged before me this 01 day of TQ ii g a r q <br />by Amps Mnrm,CE as 1 A Mr? rr/6 Er of SS <br />????, MA3r ? (; <br />o Public <br />r- NOTARI, <br />My Commission expires: _ La - 1 e, Cy <br />PUBOO .'Q <br />SIGNATUI2EAT'BE h1?71?t1\ INK <br />`?? <br />-gF,CC`00