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i) <br />Certifleadon: <br />-6- <br />L..: ) <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of <br />the following terms and conditions: <br />All necessary approvals from local government have been applied for (Section 34-32.5-111(1)(a)(1O); <br />2. This entire mining operation will not affect more than 30 acres; <br />3. This mining operation will not adversely affect the stability of any significant, valuable and permanent man-made <br />structure(s) located within two hundred (200) feet of the affected lands. (However, where there is an agreement between the <br />applicant(operator and the persons having an interest in the structure that damage to the structure is to be compensated for <br />by the applicant/operator (Section 3432.5-115(4)(e), C.R.S. 1984, as amended), then mining may occur within 200 feet. <br />Proof of an agreement must be submitted to the Office prior to the decision date.) <br />4. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-115(4)(f), C.R.S. 1984, as amended); <br />5. As the applicant/operator, I do not have any mining/exploration operations in this state of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials <br />(Section 34-32.5-120, C.R.S. 1984, as amended) as determined through a Board finding. <br />6. 1 understand that statements in the application are being made under penalty of perjury and that false statements <br />made herein ate punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984, as amended. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-111,C.RS., of the Colorado <br />Land Reclamation Act for the Extraction of Construction Materials. Any alteration or mod fcaden of this form shall result In <br />voiding any permit Issued on the altered or modified form and subject the operator to cease and desist orders and "penalties <br />for operating without a permit pursuant to section 34-32.5-123, CRS. <br />Signed and dated this day of ??//? ypr ZOO 7 <br />Applicant/Operatar If Corporation Attest (Seal) <br />???/rro5c?.?/lI B <br />BY. <br />Title.. /?o? r An <br />State oft/1??? ) <br />County of y?y-? 1 ss. <br />The foregoing instrument was acknowledged befo a this..- Gay of <br />?y) <br />bYas ltrr, .!"/.(/lam <br />Y= <br />orate Secre or ui ent <br />Town/City/County Clerk <br />?d0'7 <br />v -- <br />blic <br />y Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />M lmidxrum,vammreCoauwNiontI I (Approval 03/1112005)