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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 />I. All necessary approvals from local government have been applied for (Section 34-32.5-110( 1 )(a)(V I I I), <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 34-32.5-11 5(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 />4. As the app I i can t/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 Materi als (Section 34-32.5-120, C.R.S.). <br />5. 1 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 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 34-325-110,6 R.S., of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this form shall result in wilding anv <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 34-31.5-113, C. R.& <br />Signed and dated this 3(S day of ) p ??? ,-i L r 7 QQ <br />J ? a nx r / l't ?c" - l <br />Applicant/Operator <br />Signed: <br />"Title: {? d i LCD/ r ve <br />State of (1) Ily/) &) ) <br />ss. <br />County of I„G ) <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing ?instrument was acknowleed-ged before me this ? day of <br />by ?ld CI?1C? &41- fi? r21p ?l?l as <br />464-0. <br />of LL?. <br />otary ublic <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />If Corporation Attest (Seal) <br />Signed: <br />nB%L-%C