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ME <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/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- 11O,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 <br />without a permit pursuant to see Action 34- 32.5 -123, C.R.S. <br />Signed and dated this 2 S day of 3 � k �ORPORgT� 9y <br />3 _ _�1 —1 _ <br />ee, 4 � ,�G, C. If Corporation Attest (Seal) y ' S At �- <br />Applicant/Operator %,Z�p, • 0 =� <br />Si Sign : <br />Corporate Secretary o Equi ent <br />Title: il�, f Cc v� �2 �i 2i/ Town/City/County Clerk <br />State of ) <br />ss. <br />County of�(�r.r�c� ) <br />The foregoing instrument was acknowledged before me this ,Ia day of C(-\&Y CV-\ a D 1 , <br />by as PC�&)PA pb� c/ of <br />ota lic <br />My Commission expires: I - -,1- 1!Z2 <br />SIGNATURES MUST BE IN BLUE INK DEBORAH L. MORGAN - ROTARY PUBLIC <br />COUNTY OF STATE OF <br />LARAMIE WYOMING <br />MX Commission res l <br />