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-7- <br />As an ruthorized 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(1Xa)(VIll). <br />L To the best of my knowledge, all significant, valuable and permanent man-made strucb me(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(4xel 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 3432.5-115(4x!), <br />C.R.S.). <br />4. As the applicant/operator, I do not have any mininglexploration operations in the State of Colorado currently in violation of <br />the provisions of the Colorado Land Reclamation Act for the Extraction ofConstruction Materials (Section 3432.5-120, C.R.S.). <br />5. I understand that statements in the application are being made under penalty of pequry and that false its made herein <br />we punishable as a Class l misdemeanor pursuant to Section 18-8-503, C.R.S. 1984. <br />T hkjorm has been approved by the Mfieed Land ReclamaMm Boardpursuant to secdoe 34-32.5:110,CRS, of the Colorado Lard <br />ReefannotonActfordoe EkvacAm ofConsowcAm Meter&& Any attenadon or=Mjkadon ofthh formshagrmkIn vdd/ng any <br />perawk fawned on the altered or nrodl W form and subject tlbe operetor to cease and desist orders and chU peneWa fer operadag <br />wltheia a pernrlt pursuant to section 34325123, CK& <br />Signed and dated this /f I' day of ?y G <br />If Corporation Attest (Seal) <br />Signed: <br />C Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this 1 y? day of r T l ou'r- - , on I <br />41 <br />by • Scd- Lamb as 6VIgIX,,P'=C14,0MIUM. of c s-jaiil & ne.L. uG <br />a oz,.Ij f.401A . <br />N-K" . dR-lc- - - j <br />?V OTAR/» t'? My C fission expires: <br />SIGNATURES MUST BE IN BLUE VM <br />O. <br />?? C <br />11111111 <br />MY COMMISSION EXPIRES <br />JULY 93, 20 L2?_ <br />ss.' <br />County of /?fyl'ka