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<br />-~- <br />Certification: <br /> <br />As an authorized representative of the applicant, 1 hereby certify that the operation described has 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 34-32.5-1 I5(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-I IS(4)(f), C.R.S.; <br />3. As the applicant/opetator, 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 Constrttction Materials (Section <br />34-32.5-120, C.R.S.) as determined through a Board fording. <br />4. [understand that statements in the application are being made under penalty of perjury and that false statements <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this 2`J4M=day of l~(o.tF_n~L,c~:z , ,2GGU <br />Applicant/Operator or Co pany Name <br />Signed: ~~~ <br />Title: VICE hL~t.~c,eu'f <br />State of CCLl:0.AC~U ) <br />ss <br />Counry of ~A e. m~e_ ) <br />Town/City/County Clerk <br />The foregoing instr/u~ment was acknowledged before me this ~ i ~ k day of 1 ~ n v Ln~~i e ~ , ,2~p~_, <br />by KtNUe-11,~ l I~11.I..Y~N aS Ij II~.F ~f~i ~; I.lEu {- Of~~. YLL£yi n~n~l •.i ~ nq, .tom <br />If Corporation Attest (Seal) <br />Signed: k.1~.~_..,,_ V' ~~..~_.~~1-., S~ <br />Corporate Secretary or Equivalent <br />Notary Public <br />My Commission expires:llV~a~2G .tCr n1~ <br />SIGNATURES MUST BE IN BLUE INK <br />M:N4MSFWtE~V$FORMSVBS7COII.APP OLIM99 <br />