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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 />I. All necessary approvals from local government have been applied for (Section 34- 32.5- 110(lxa)(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/operator, 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- 110,CR.., of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this 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, G S <br />• (( r <br />i <br />Signed and dated this L` day of -<- c '►J rLt a. c <br />V A A' /GGK s.4r/d 44, e. t2 dt U 6._ If Corporation Attest (Seal) <br />Applicant/Operator <br />Signed: / /2 -6i,P [ -- <br />Title: L/ u/ive iQ <br />State of <br />County of VU L'[ )) . <br />The foregoing instrument was acknowledged before me this > 1 < k <br />, by - 1 - t t t 0e1)-C as ( ' .tur\ --t <br />SIGNATURES MUST BE IN BLUE INK <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City /County Clerk <br />day of --_ 1 ru .rt, <br />of <br />blic / <br />My Commission expires: t�� / - 0 - 0_03 <br />_ �; '_ <br />� • 6 1.Atis;:4 <br />