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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 34-32.5-110(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 the applicant/o:perator, 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. I 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 Mined Land Reclamation Board pursuant to section 34-32.5-1104 iM of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials Any alteration or modification ofthis form shall result in voiding any <br />permit issued on the altered or modified 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, CX& <br />Signed and dated this 1-7 day of ? e-c &y r V3 er,- <br />-\C Q L Y-,, Co ?s t If Corporation Attest (Seal <br />Applicant/Operator <br />e <br />Signed: Signed: <br />Title: Land Use Administrator <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of ? 6 JC) P0. C(,L--) I A) ss. <br />County of " CC) ) <br />The foregoing instrument was acknowledged before me this / day of ?C 2010 <br />t??P.y? nn / J <br />, by T AWp - MO-r r as a?n vAJ QdM41:S±&ACof _CZ ? C? L ( 11 <br />LISA M CRAV1400D Notary Public <br />Flo" PIlf1 IC a <br />Raw of colotaft My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK