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Mine No 1 Application Form Signature Page for Craig to Sign 11-20-2023.pdf <br /> Catiftaflan <br /> As an authorized representative of the applicant,t hereby certify that the operation described has met the minimum requirements <br /> of the following terms and conditions: <br /> 1.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 within200 feet ofthe proposed affected area have been identified in this application(Section <br /> 34-32.5-115(4Xe),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(4Xfk <br /> C.I.S., <br /> 3. As the applicant/operator, 1 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 34- <br /> 32.5-120;C.&S.)as determined through a Board finding. <br /> 4.l 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 /> This form has been approved by the Mined Land Reclamation Board pursuant to sec on 34-325.112,C:RSi of the Colorado Land <br /> Reclammtian Act for the Evtractiion ojConstriecdon Materials Any alteration or nrv4ficstiam of this form shalt result in vaidimg arty permit <br /> issued on the altered or modified form and subNe t the operator to cesse and desist orders and cdvil penalties for operating without a permit <br /> pursuant to section 34-32 5-123,GIG 1& / <br /> Signed and dated this day of /�l V 2023. <br /> If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name: W uipment&Truck Mine#1,Craig Sparrow,President <br /> Signed: <br /> Craig Sparrow, i t <br /> State of Colorado) <br /> )ss. <br /> County of Weld) <br /> eaThe foregoing instrument was acknowledged before me this day of Y ©V CJ ,2023,by Craig <br /> Sparrow as)'resident of Western Equipment&Truck,Inc. <br /> / CARLA RAE HARDING <br /> Notary pub) NOTARY PUBLIC-STATE OF COLORADO <br /> NOTARY ID 20224038084 <br /> MY COMMISSION EXPIRES SEP 29, 2026 <br /> My Commission expires: ! <br /> SIGNATURES MUST BE IN ILUE INK <br /> -fa- <br /> 1 of 1 11/27/2023,8:00 AM <br />