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Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation <br />described has ptet the minimum requirements of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made <br />structure(s) in existence at the time this application is filed, and located within 200 <br />feet of the proposed affected area have been identified in this application (Section 34- <br />32.5-115(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by <br />-law -(Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicant/operator, I do not have any extraction/exploration operations in the <br />State of Colorado currently in violation of the provisions of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S.) <br />as determined through a Board finding. <br />4. I understand that statements in the application are being made under penalty of <br />perjury and that false statements made herein are punishable as a Class 1 misdemeanor <br />pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this Q�_ day of <br />Applicant/Operator <br />Signed:p� <br />Title:rw,`�`�c� Uy <br />State of <br />If Corporation Attest". {Seat) <br />Signed: 6ztwd t/ L-\2- <br />Yzz <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />ss <br />County of ) <br />The foregoing instrument was acknowledged before me this, clay of , <br />by as <br />%7 <br />Notary Public <br />r41CiOlilf IUlon fires 5.31-91 <br />� ' ssion expires: <br />01/02/96 ZMFCO.112 <br />