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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 teens 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 3432-5-115(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(4)(f), <br />C.R.S.). <br />4. As the applicant/operator, f do not have any mininglexploration 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, CRS.). <br />5. I understand that statements in the application are being made under penalty ofperjury and that false statements trade herein <br />are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />This form has been approvedby the Mined Land Reclamation Boardpursuant to section 34325-IJ0,C.R-S, of the Colorado Land <br />Reclamation Act for the Extraction of Construction Material& Any alteration or modification of this farm shall result In voiding <br />army 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 section 34-3?2.5--123, CRS. <br />Signed and dated this $? day of <br />6. f <br />If Corporation Attest (Seal)", <br />Applicant/ rator #' ' + <br />Signed: G- Signed r ,. <br />..:0 .. ?.:. :i <br />Corporate Secretary of t'valer t <br />Title: Town/City/C l inty'Clerk <br />?J <br />State of W 1wa _l <br />) SS. <br />County of ?1.tY?nP-tiz <br />The foregoing instrument was acknowledged before me this day of <br />b as of Id. P'' LL <br />Notary Public / U <br />My Commission expires: Gl " ?? ' ?B <br />SIGNATURES MUST ICE IN BLUE INK <br />5?j`e5 <br />?it