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03-MAY-2010 04:07PN1 FROM-DIV RECLAMATION MINING i SAFETY <br />-7- <br />Certilir9rinn: <br />As an authorized rcpresentativc ofthe appl ]cant, i hereby certify that the operation described has met the minimum requirements of the <br />following; terms and conditions: <br />1. All necessary approvals from local government have been applied for (Section 34-31.5-110(1)(a)(Vlll). <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 300 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(4)(e), CALS.). (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 334-332.5-113(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 ofthe Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.S-120. C.R.S.). <br />5. I understand that statements in the application arc 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. 1484. <br />This form has been approved by thehlined Land Reclamation Board pursuant to section 34-31.5-I10,C.2S., of the Colorado Land <br />Reclamation AcrfortheF-etracdonofConstruction AlaterlaLs stnyalteration ormodificationofthisfornrshall resultlnvoiding any <br />perlait issued on the altered or modified form and subject the operator to cease and deslst orders And civil penalties for operating <br />without a permit pursuant to section 34,32.5-1U C R.S. <br />Signed and dated this a d 7 `% day of A tom' ? t t- , ?(? f Q <br />CC- I, <br />Applicant/Operator <br />Signed: <br />'title: =ts3?r t o . flF nP E%K-6ig3S <br />+3038328106 T-830 P.008/000 F-720 <br />If Corporation AUSt (Seal) <br />Signed: <br />Town/City/County Clerk <br />Corporate Secretary or Equivalent <br />State of C.0 sm"'L4_6 -3>4= <br />ss. <br />County of G.e-. NN : Soy ) <br />The foregoing instrument was acknowledged before me this 3o t day of obit/- <br />, by <br />as <br />Notary Public <br />My Commission expires: <br />of <br />*s APRIL <br />SIGNATURIES 1%1UST BE'IN:QLUE*INK 4 <br />;? -2011