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RECEIVED <br />• APR 17 2001 ~ RECEf VED <br />" - APR 1 0 1001 <br />Certification: Division of Minerals and Geology <br />Division of Minerals and Geology <br />As an authorized representative of the applicant, I hereby czmty [hat the operation described has met the mmunum requirements <br />of the following terms and conditions: <br />1. To the best of my Knowledge, all srgnificant, valuable and permanent man-made structure(s) in existence at the tune this <br />application is filed, and located within 200 feet of the proposed adected area have been identified m this application <br />(Section 3d-32.E-I l~(4)(e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Secuon 34-325-1 I~(4)(f), <br />C.RS.; <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 Construction Materials (Section <br />34-32.5-120. C.RS.) as determined through a Board finding. <br />4. I understand that statements in the applicaion are being made under penalty of perjury and dtaz false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this .9_ th day of <br />-~.~..:~ ~~.~~ 1 ~~, BED ~o» <br />Applicant/ ator or Company Name <br />Signed: k, <br />[f Corporation Attest (Seal) ., <br />Signed: \~i `~tC.fC~(.3C~ <br />Title: ~ ~ . ~ <br />State of Colorado ) <br />ss <br />County of Bent <br />Towe{6ity/County Clerk <br />The fore~oing instrument was aclmowledged before me this % LfL day of ~ , ~nn/ , <br />by V l /~/ F4 a(~t 1P~'/Y'Al T~ as /~ Dm i N~S7/~/-I TD.~ of o <br />Notary Public <br />' - - - My Commission expires: ~Y ~/ <br />SIGNATURES MUST BE IN BLUE INK <br />