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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 mquirements of the <br />following terms and conditions: <br />All necessarv 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 legit of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(4)(c), 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 currently in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction ol'Construction Materials (Section 34-32.5-120, C.R.S. ). <br />5. 1 understand that statements in the application are being made under penalty ofpequry 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 />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-110,0. &S., of the Colorado Land <br />Reclamation :4 c1 for the E.rtraction of Construction Materials. Ant' alteration or modification of this form shall result in voiding an1• <br />permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating <br />without a permit pursuant to section 34-32.5-123, C.R.S. <br />Signed and dated this ? f day of A%?4 y -? Ln <br />F C61NHS X 0,- T/D/V <br />? L L1f Corporation Attest (Seal) <br />Applicant/Operator <br />Signed: 4 Signed: <br />Corporate Secretary or Equivalent <br />Title: Town/City/County Clerk <br />State of t c' (C /? cz'?iC?? ) <br />/r4,1 County of 1,e`,4- ) <br />Tom-- / <br />The foregoing instrument was acknowledged before me this day of <br />by l >?cCa?C /<U??r)S as /-a Y .rte ?' of <br />4 AA-J_, ) f 'J 6 )C? tom, <br />Notary Public <br />My Commission expires: J• t 0 • / <br />SIGNA7TRE'S Ml1S'r BE IN BLUE INK