2010-03-15_REVISION - M1999022

• Permit No: M1999022
• IBM Index Class Name: REVISION
• Doc Date: 3/15/2010
• Doc Name: Notices
• From: DRMS
• To: Various
• Type & Sequence: AR2
• Email Name: RCO
• Media Type: D
• Archive: No

-6-
Certification:
As an authorized representative of the applicant, I hereby certify that the operation described
has met the minimum requirements of the following terms and conditions:
1. All necessary approvals from local government have been applied for
(Section 34-32.5-110(1)(a)(vilLi .
2. To the best of my knowledge, all significant, valuable and permanent man-made structure(s)
in existence at the time this application is filed, and located within 200 feet of the
proposed affected area have been identified in this application (Section 34-32.5-115(4)(e),
C.R.S.). (NOTE: For 110 operations, the affected area includes all lands delineated by the
permit boundary.)
3. No mining operation will be located on lands where such operations are prohibited by law
(section 34-32.5-115(4)(f), C.R.S.).
4. As the applicant/operator, I do not have any mining/prospecting operations in the State
of Colorado currently in violation of the provisions of the Colorado Land Reclamation Act for
the Extraction of Construction Materials (Section 34-32.5-120, C.R.S.).
5. I understand that statements in the application are being made under penalty of perjury
and that false statements made herein are punishable as a Class 1 misdemeanor pursuant to
Section 18-8-503, C.R.S 1984.
signed and dated

if corporation attest (Seal)
of
Signed:
Title:
State of
Signed:
Corporate secretary or Equivalent
Town/city/County Clerk
) ss
County of )
The foregoing instrument was acknowledged before me this ?k day of ,
by
as
my commission expires:
SIGNATURES MUST BE IN BLUE INK
of

r N ary/Pulr71 c
4/ 1111
01/02/96 nnFG0.110