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• Certltteatlon: <br /> <br />-8- <br />As an audrori~d representative ofthe appflcant, I hereby cxrtifydmt the operation described has met the minimum requirerricnts <br />of the following terms and conditions: <br />1. To the best of rrry krrowledge, all significant, valuable Gad pemaartent man-made slrueture(s) is existence at the time <br />this application is fited, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 3432.5-115(4xe}, C.RS.). <br />2. No mining operation wi0 be located on lands where such operations are protulMed by law <br />(Section 3432.5-115(4xf), C.RS.; <br />3. As the app6canUOpetator, i do not have any exlractiorJexplaation operations in the State of Colorado currently in <br />violation of the pmvisiens of the Colorado Land Reclamation Act far die Extraction of Construction Materials <br />(Section 3432.5-120, C.RS.) as detemtined through a Board finding. <br />4. 7 understand that statements in the application are being made wider penalty of pequry and that false status <br />made herein are punisirabk as a Class 1 rrrisdemeazsa pursuant to Section 18-$-SO3, C.R.S. <br />Th& farm bas beew approxaJ by thsAlfwed Laved Rsdwuatlow 8mrd pwrseawt ro saAiaw 34-325-112,1~R.S, oftbt Calonadn Laved <br />RectaarapfowActfortlreFssraetJawafCowatroedan6fa0er~ls. Awyat4eretfonorwwdijleaffowofrhtsformsAralfraakJwvofdlw8awy <br />perm8 faxed oa the ahead or w,od{/led form awd rxbject the opaatar m esasr awd desi# orders awd dNl pewattles jar opemNwg <br />tolthom o pttsiit parsuau to srUlow 3t-.i25-72J, C.RS. <br />Signed and Gated this TlT ~l~l Gay of Nl7t'Firi* SEA 200 <br />ApplicantiOperator or Cotttpany Natnc <br />Signed:/~ ~ 'c~¢'s~t°"r'" Or" <br />~ ~ ~ ~0 <br />Title: <br />If Corpaaation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of ~-OtlG~rl ~Dt~ ) <br />AA ) ss. <br />County of ~~S ~1i1tYllAS ) <br />The foregoing instrument was ackrrowleaged before me this _~ day of _ / ! IJIJ!°~2.LA ~~P <br />_,by F~~t< L'.eoxcT~ SppAre~°'taeg ~~ti~gers of /tl~rle SAnn e` 4rGve/ LLC <br />~ ~ ' _ -~,~ Notary Public <br />~~ <br />,' O ,l ~ O <br />`. My Commission expires: a O 9 <br />/Lor <br />•~' ° ~''~ ''' " SIGNATIIRES MUST BE IN BLUE INK <br />w~6 ...,..~-. t: <br />M:m~~r~ri«, nZ.oo~ tnvwaKaos/i ~rzoost <br />