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-R- <br />C'ertificulion: <br />As an aulhori/ed representative of file applicant. I hereby certify that file operation described has met the minimum <br />requirements ol'the lollowing terms and conditions: <br />1. I o the hest of my knowledge, all significant. valuable and permanrnf man -made structures t in existcnec ;u the Inns <br />this application is filed. and located within 200 feet ofthe proposed allccted area have been idenfilied in this application <br />(Section 34- 32.5 -1 I5(4)(c)• C'.R.S.). <br />2. No minim, operation will he located on lands %khere such operation arc prohibited by I'm <br />( Section 34 -32.5- I I S(4)(1). C.R.S.: <br />3. A% the applicant /operator. I do not have ally extraction /exploration operations in the State of'Colorado currentl\ in <br />violation of the provisions of the Colorado Land Reclamation Act liar the Extraction of Construction Matrri,rl. <br />(Sect ion 34-32.S -120. C.R.S.) as determined through it Board finding. <br />a. 1 understand that statements in the application are heing made under penalt} of perfur\ and that false slatemewN <br />made herein are punishable as it Class I misdemeanor pursuant to Section I8- 8-S03. C'.R.S. <br />This font him been approved hr the Alined Land Reclamation Bourd pursuant to sec uon 3d- 31.S -/ /1,C.K..S., n/ the Colorado Land <br />Reclamation Act for the Ertrac•tion of C'onctreetion Materia /s.: n'I- alteration cnr nno 4ication of this fr <br />on %hall remill in voiding unjr <br />permit Awed on the altered or naoified form and subject the operator to ceam, and denim ordem and civil pcn{ltie% for nperatint; <br />without a pernit pnrwant ln7.section 34- _11..5 -113, CR.S. <br />Signed and dated this / day of kc " �� ix,3 <br />l <br />�YSC <br />Applicant /Operator or Company Name <br />Signed. zu <7 14C� <br />I itic: <br />State of (: GlQ i f" ) <br />ss. <br />County ) <br />If Corporation Attc,,t (Scab <br />Signed. 4 .� <br />qo��crela or I.yrikillcri <br />1(mn /Citti /County Clerk <br />The (irregoi) ! instnunent vas acknuvvledgect heliire n this da\ of <br />-- - - -- <br />Notar\ Public <br />rf <br />tvly Commission expire.: <br />SIGNATURES MUST BE IN BLUE INK <br />You must post sufficient Notices at the location of' tile proposed mine site to cleark identik the situ as the location cal a <br />