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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 />All necessary approvals from local government have been applied for (Section 34-32.5-1 10(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 tiled, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(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, 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 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 34-32 5-l10,CR-&, of the Colorado Land <br />Reclamuad on Act for the Fodracdon of Construcdon Materials Any alteration or mod ficadon of this form shall result in voiding any <br />permit issued on the altered or modiJled form and subject the operator to cease and desist orders and civil penalties fur operating <br />without a permit pursuant to secd n 34-32.5-123, CAS <br />Signed and dated this S day of -,1ZO/ 0 <br />f, <br />E? <br />'Applicgtjperator . <br />Signtr'1d.'/- <br />T i t?e -.?- I *t <br />State of ) <br />) sS. <br />County a I16 1-? ) <br />If Corporation Attest (Seal) <br />Signed: _ <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this < day of IC) t <br />by ?C t G. y'? ?? 1tif ? ? 5? a.? i t G-G?t't7l () ?-"?u. ? .+L- 1.?143r ? t}f ? Fm-?-r tl !.4 ?_L+u. rte `E+-? <br />iRY iot< public <br />SIGH <br />KATW A~ <br />YHO <br />OUST ME IN <br />,r <br />mission expires: _ t P - - <br />IN.