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~t-01 ~ h1 `6~t0~ <br />~~ U ~ ~~~ ~ ~ -o i ~ RECEIVED <br />`~ ~'Yv,~l-e~F~~ss ,~ OCT 2 4 2006 ~ <br />Division ofe d 58 Lyon. <br />Minirtg <br />CertfRcatfon: <br />As an authorized repreuntsrive o(the applicant, l hereby ccrtify that the operation described has met the minimum requirements of the <br />following terms and condirioas: <br />All necessary approvals 6om local government have becn applied for (Section 34-32.5-I 10(1)(a)(Y111). <br />2. To the hest of my lmowledgq all significant, valuable and permanent man-made sbucwe(s) in existence at the rime this <br />application is filed, acrd located within 200 fret of We proposed affected area have been identified in this application <br />1Section 34-12.5-1 TS(4),c), C.R.S.). (`TOTE: For 110 oparatiorts, the affected area includes aJ) lands delineated by Nu pemait <br />boundary) <br />~, No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-1 IS(4)(f), <br />C.R.S.). <br />app)icantlapentor, 1 do nut have any mining/explorarion operatlorn in the State of Colorado currently in violation of <br />provision of the Colorado land Ralarnarion Act for the Extraction of COtISn7lCtinn Materials {Section 14.32.5-120, C.R.S.). <br />5. 1 wderstand that statemeab in the appliarion arc being mods under penaltyotperjury and that Cale statements made herein <br />are punishable as a Class 1 tnisdemearror pursuant to Section 18-8-503, C.R.S. )984. <br />77rbjorm has been opprored by theMinedl.and Rmlamation 8aordpursaanttouction 31-3L5-710,C.RS, ojthe Colorado farad <br />Reclamallan AMfor the Extraction ojConstraerion Materials Any aheraNan or modtJFcation of this jorm shaft resah !n voiding <br />any permi! bsaed oa the shred or modiJled jorm and sabjen the operator to reau and desist orders and eivll penalties jot <br />operating withoat a permit pursuant to section 3I-32.3-123, C,R.S <br />Signed and dated Otis <br />day of <br />Applicant/Opttator <br />Signed: <br />Tide: _~„(q~ <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretvy or Equivalen! <br />Towrv'City/County Clerk <br />~~'-• OFFI(YALStn~ f <br />state of `,e(//,l_~„Z ) MANDY BOGAC2 <br />ss. NOTARY PUBLIC - State al Aritun <br />MARICOPA COUNTY <br />County of ,~___) fdy Comm. 6yitas Nov 14.20~09i 1 <br />'(he foregoing instnunem was aclQmowtedged before me tins 1`~h day of~{;.ccr_, h~Q <br />~, by -_ fPa C..Z.. as of <br />-= lUv+kt~~. r Gl~ Cd¢c cth . <br />Notary P tic <br />My Commission expires: ~VUVVV L- ' _ _ <br />STCNATITRES MUST BE IR BLUE I\K <br />N ~min`sFarc`vtfonns`CaluWCtion110 (Approved Ob 112M}) <br />