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Certification: <br />As an authorized representative ofthe applicant, I hereby certify thattheoperation described has met the minimum requirements ofthe <br />following terms and conditions: <br />Signed: <br />1. All necessary approvals from local government have been applied for (Section 34 -325- 110(1Xa)(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(4Xe), 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(4X4 <br />4. _._ As the applicant/ operator, I do not have any mining/ccploration opt in- theStatenfColorado-ranreoilyin violation of <br />the provisions ofthe Colorado Land Reclamation Act forth; Extraction ofConstruc t ion Materials (Section 34-32.5-120, CRS.). <br />5. I understand that statements in the application are being made underpenaIty ofperjwy and that ia1se statements made herein <br />are punishable as a Class 1 misdemeanor pursuant to Section 18- 8-503, C.R.S. 1984. <br />Thisfonnlias been approved by the Mined Land Reclamation BoanIpw ttosection34-3Z5-IIgCKS, *Me ColoradoLand <br />RedarnafionAdfortkeExboefioateConstrudionMateriak. Any alt on or ntorgicadonofddsfonns ire invoidingany <br />permit issued on the armed or snodifiedfonaa and subject the operator to cease and desist orders and cdvil penalties for operating <br />without a perraftpursmad tosectkm 34- 32.5.123, C.R.S. <br />Signed and dated this a4 ' da o f j d A ,� {— 2011 <br />Harry Colkle Coast <br />Title: President <br />State of Colorado <br />Applicant/Operator <br />County of Jackson ) SS. <br />The foregoing instrument was acknowledged before me this <br />by Ham' Codde as President <br />- 7 - <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City /County Cleric <br />,9 9 day of A Uyt <br />DEBRA L GREENE <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />My Commission Exntres O6/2� <br />NATURES MUST BE IN BLUE INK <br />Notary Public <br />of Reny Corkle Coast <br />My Commission expires: 2 03/ P., Q <br />