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~6M A ~I~~i ~ soy Tii~c~i~J- 6 - <br />ff ~~/t-hr~~~ri ~, InC <br />Certification: ~. A1E'ZheSS/ <br />RECEIVED <br />NOV 2 5 2002 '~ <br />Division of Minerals and Geologp• <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 condifions: <br />All necessazy 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 (Section 34-32.5- <br />115(4)(e), C.R.S J. (NOTE: For 110 operations, the affected azea includes all lands delineated by the permit boundary) <br />No mining operation will be located on lands where such operations aze prohibited bylaw (Section 34-32.5-115(4)(f), C.R.S J. <br />4. As the applicandoperator, I do not have any mining/prospecting operations in the State of Colorado cturendy 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 Secfion 18-8-503, C.R.S 1984. <br />Signed and dated this ~~ day of r~ ~~g at .~/~ D~ <br />,+' ~ ~ ' <br />„= - <br />Anthonv A. Blasi IfCorporafionAttesr(SeSt),+; y 1~=;' <br />ApplicandOperator = r-= - _ " <br />/n/ - ~ //}~ ,~ <br />Signed: G~-.A~i ~ G,~.~ ~/?~ <br />Signed: <br />- - , <br />Secretary or <br />Title: President <br />State of Colorado <br />ss. <br />Cotuityot Nuer-f-ano --~ - <br />TowrilCity/County Clerk <br />The foregoing instrument was acknowledged before me this ___~_~ ~.~ day of ~ ,( X,,/~,r,Ll~ , ~, by <br />fa•• Bif+s/ ~ a.~ <br />~, n-V-h~,h~_PL~s, as ~Y't?,r~icrQV~~ ofrr`,EVino. .ti=Hr~l.rnouts <br />~h~ <br />~ ` ~-' <br />,: . ,- <br />.. _ _„ _= <br />~. r,. -. ? ~ ~ V .. <br />it ' .. - ~ <br />,~'.. .. - <br />i'Yl c~ ~ ~~.~- <br />NotTary Pub is q <br />My Commission expires: ~~' / _ a~lo <br />SIGNATURES MUST BE IN BLUE INK <br />M:NIIN~SIIARE\VSFORMS~2821CO10.APP 10/15/Ol <br />