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M- 2006- OY7 <br />7 a /a <br />l1-Wal <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 34-32.5-11.0(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 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 ineZpfilie.?6 v`ope ;rLc.,-I dJ not `a v e sr y ^:ining/explo:ate.- eper~tions-,n the.State-of Colmdo.euurrently_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 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />This form has been approved by the hfined Land Reclamadon Board pursuant to section 3432.5-110,GR.S., of the Colorado Land <br />Reclamation Actfor the F-dracdon of Construction MaterialL Any alteration or n"jicahon ofthis form shallresult in voiding any <br />permit issued on the altered or mod ijied form and subject the operator to cease and desist orders and civil penalties for operating <br />without a permit pursuant to section 34-32.5-123, C.RS.0 <br />Signed and dated his day of ?` ?? <br />Applicant/Operator <br />Signed: <br />Title: f::cor--e 'l Q h <br />State of _ <br />- ) ss. <br />County of _ <br />The forego in instrume t was ac oavledged before in <br />. by as ?C <br />If Corporation Attest (Seal) <br />'GPRSON CO ." <br />% <br />* . SEAL Corporate Secretary or Equivalent <br />r <br />Town/City/County Clerk <br />?CORA <br />day of <br />? F <br />QP <br />e <br />.= <br />.p My Commission expires: <br />1>11GJp E IN BLUE INK <br />?0° Expire$ P?g?s <br />