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Certification: <br /> As an authorized representative of the applicant,I hereby certify that the operation described has met the minimum requirements <br /> of the Following terms and conditions: <br /> I. 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.). <br /> 2. 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 /> 3. As the apphcant/operator,I do not have any extraction/exploration operations in the State of Colorado currently in <br /> violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section <br /> 34-32.5-120,C.RS.)as determined through a Board finding. <br /> 4. 1 understand that statements in the application are being made under penalty of perjury and that false statements made <br /> herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503,C.R-S. <br /> ,;�r <br /> Signed and dated this d2 / day of � ,P��.y.Gi ,moo/ <br /> �Ug o If Corporation AttesE(Seal) <br /> AQplicant/C►pt ator or am " ,game <br /> Signed: Signed <br /> Co rate Secretary or EquivalentP�'� 4� <br /> Title: Town/City/County Clerk <br /> - <br /> State of <br /> 1 <br /> )ss <br /> County of ze;,ii'i ,/) <br /> The foregoing instrument was acknowledged before me this 7/ day of ��/P f ✓ /, <br /> by of Zs�E,( �/,� r ,F <br /> No Public ` <br /> My Commission expires: ��P y/- _R <br /> SIGNATURES MUST BE IN BLUE INK - <br />