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-~- <br />Certification: <br />As an authorized representa[ive of the applicant, I hereby certify [hat the opemtidn described has met the minimum <br />requirements of the following terms and conditions: <br />l . To the bes[ of my knowledge, all significant, valuable and permanen[ man-made structure(s) in existence at the time <br />this application is tiled, and Located within 200 feet of the proposed affected area have been identified in this application <br />(Section 3~t-32.S-I I S(a)(e), C.R.S.). <br />2. No mining opera ion will be located on lands where such operations aze prohibited by law (Section <br />34-325-7 1 ~(a)(f), C.R.S.; <br />3. As the applicanUopetator, I do not have any extractionlexploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Ma[erials (Section <br />3a-32.5-120, C.R.S.) as determined through a Board finding. <br />4. I understand that statements in the application aze being made under penalty of perjury and that false statements <br />made herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this g ~ day of ~! l ~ ~ 'z U 0 0 <br />Art Beavers <br />ApplicanUOperator or Company Name <br />Signed: ~~ ~-~G~t-Gtr <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Title: President <br />State of ~.~ ) <br />ss <br />County of _-/~~T ) <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this ~ day of ~~ ~ '~~d , <br />by ~il-f >~c a.„_c.. a_ as~z ~ -,~ of ~.~- of , f ~ 2c ov ~' n..,aQ <br />lY PVQ ~ f~l <br />~~ 2 z~ <br />KAY ~ Notaryl ublic <br />'COON <br />~~~ tvly Commission expires: ~~- ~ ~~ds <br />SIGNATURES MUST BE iN BLUE [NK <br />.N`.~II~V H4RER'SFOR.~ISQe:iC01_'..aPP O'JIOPN <br />