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08/21/2009 12:27 <br />9702475104 <br />DMG DURANGO OFFICE <br />-7- <br />CetgflgAtlon• <br />PAGE 10/12 <br />As an arxthorized teprmntadvo or tile applicIM4 I hereby crrtify that the operation described has met the minimtun requirements a:f ?e <br />following terms and conditions: <br />1. All necessary approvals front local govermnent have been applied frax (Section 34-32.5-110(1)(a)(VIII), <br />2. To the best of my knowledge, all 6ignil;tcant, vahzable rind perlMnent rmn-rmde structure(s) inexistence at the time t <br />application is filed, and IwAted within ,200 ket of the proposed a1'Eeeted area have been identified in this applica[i <br />{Section 34-32.5-115(4)(e), C '.S.). (rlor.:For i 10 operations, the affected area includes all lands dolineafed by the permit <br />boundary.) i <br />. <br />3. No milting operattian will be located an lands where such operators arc prohibited by law (Section 34-32,5-115(4)(fj, <br />4_ As the applicant/opmator, I do not have any mining/exploration operations in the State ofColorado cuotently in Violation of <br />the previsions Ofthe Colotndoland ReclainationActfor the Extraotion o.FConstrucdonMaterials (sec6m 34-32.5-120, C.R,S.). <br />5. 1 understand that stakinents in the application are being made under malty ofpedury and that false' stat+etyorft trade heroin <br />are punishable as a Class i misdemeanor putsnant to Section 18-8-$03, C.R.S. 1954. <br />Tick forms has b"" apptwved by dw Mled Load Reelpmadom Board pursuant to sd?Won W2. 511 B,C.P-X, of the Colorado L g d <br />Reclasrtsttian Act for the )7,xrimattop of Construelfotl Materials. Any allaradoa or mWicadPora of tkis3"orm shall resR& iii voiding <br />arty permit isseted on the altered or mod fed form and wbject tike operator to cause and desist orders and civil penalties for <br />olierat *g Wlhaut a perw t pursuant to section 34-32,5-123, CRS <br />Signed and dated this <br />day of <br />Applicant/Operator <br />Signed: ,i lcl;cel?? <br />Title: <br />State of <br />)58. <br />cmwty of <br />.. . <br />If Corporation Attest (Seal) <br />Signed; <br />COrporatc Secretary Or Equivalottt <br />TOwnlCity/County Clerk <br />f fpr going ims mat vtras a clcnowledgcd before we this _ clay of <br />?tllitlttiuOd? y (.,1 L <br />C? Notary Public <br />. L 13r]?1?( <br />%. i ado ?D U9 <br />? My Gotrunrasion expires. <br />o <br />t t ATU T BE IN SL€ X, rNX