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<br />s <br /> <br />-~- <br />Certification: <br />As an authorized representative of the applicant, [hereby certify that the operation described fins met the minimum <br />requirements 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 <br />this application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-I 15(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section <br />34-32.5-IIS(4)(f), C.R.S.; <br />3. As the applicant/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 ConstruMion Materials (Section <br />34-32.5-120, C.R.S.) as determined through a Board fording. <br />4. I understand that statements in the application are being made under penalty of per}ury and that false statements <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />TI-f <br />Signed and dated this S day of ~~^ t..l r ZU t7 ~ <br />l'!a . albQ ~4 SnLuS+ri ~ - If Corporation Attest (Seal) <br />ApplicanUOperator orCompany sore W~si- Ccr~*al ~i° ^ ~ T-t'G - <br />Sign~~f ~ ~--~--~ <br />Title: U tLr~ I~f7~~. 5 i ~~NT <br />State of ~.~X~)O~C7O- ) <br />ss <br />County of ) <br />The foregoing instrument was acknowledged before <br />by ~1~CNA•Et- G i:EF~2 as l~. <br />Signed: <br />Corporal Se ~retary or Equivalent <br />meths ~1~ day of ~ ll,~/ <br />I of ~`~ <br />~,HUr~y v~~ ~~'~~~ <br />• <br />~ ~~~ _ g Notary Public <br />TownlCity/County Clerk ";_`'; <br />_` <br />- ;" -. <br />E • o00 <br />~ a0.r.¢. <br />r~.yll~cac My Commission expires: CXXP~t~P,t ~ 3 ~bD~ <br />I <br />SIGNATURES MUST BE IN BLUE IP[K <br />M:VAMSNARE\VSFORMS12827C013.~PP OLIO'99 <br />