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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 terns and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-110(l)(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(4xe), C.R.S.). (NOTE: For l 10 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 3432.5-115(4)(f), <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 3432.5-120, 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 parsmant to section 34-32.5-110,C t &, of the Colorado Land <br />Reclm> don Actfor the Extraction of Construction Materkk Any alteration or modi#icadon of tbisform shalf result In voiding any <br />permft issued on the altered or modVied form and subject the operator to cease and desist orders and civilpenadin for operating <br />without a permit pursuant to section 34-32.5-123, .RS. <br />Signed and dated this ,2. 2nd day of OGtQjDer , - 2nnA <br />If Corporation Attest (Seal) <br />Y Nd "OdM-IF SEAL X- <br />Signed: <br />.D. Bryant <br />Signed: <br />Title: _ Manager `-_`1 <br />1 <br />State of Qk3;;hnma <br />) ss. <br />County of Oklahoma <br />The foregoing instrument was acknowledged before me this 22nd <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />day of October, 2009 <br />,by S.D. Bryant as Manager /of Ti Prraa Pi Pdra Ranc-h _L LC <br />j? <br />GV _a'_ &/..- <br />Notary Public <br />My Commission expires: c+"c`"1 '?'? w <br />SIGNATURES MUST BE IN BLUE INK t <br /># 02M9335 <br />EXp. 0529110 <br />111111111