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Certification: <br />State of L ) <br />ss. <br />County of Lb_ , ( r v 1 ) <br />The foregoing instrument was acknowledged before me this <br />- 7 - <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 />1. 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/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,C. R.S., 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 `, �R P 101g , '', <br />without a permit pursuant to section 34- 32.5 -123, C.R.S. �P . . .„1- • Signed and dated this 2 1.A( d ay of ) "\a 1 t--- ? / � OORPORATE 17 <br />• LE. J ►`s tty� • �` <br />Z <br />m $8At l ( j /G' �� S 6.,-,-,,,,) G" � �c ; i 1 f i Ti 1 L %' If Corporation Attest (Seal) 7 :-‘ 3 . 1 ' <br />Applicant/Operator '; %; • • . • • . <br />..I ''Ii M1:�` <br />/ ��1 / O 11111111`` <br />Si —/V e - - - c Sign__ /44- ...-/- /,/71:�4{ <br />Corporate Secretary or Equiaent. <br />Title: 2)) ,4, r 1 c{ 1-L q- .., ti v Town /City /County Clerk <br />r r a <br />SIGNATURES MUST BE IN BLUE INK <br />day of 1 •i <br />as I . , 1 1 I �' �, ; .. )N v r; *_ , of . 1- <br />Notar_yyPtiblic <br />My Commission expires: I.), -,1 <br />DEBORAH L. MORGAN - NOTARY PUBLIC ( <br />COUNTY GF, STATE OF <br />LARAMIE WYOMING <br />M Commission E res <br />