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~.. <br />Certificatioa: <br />- ~ - <br />As an authorized representative of the applicant, I hereby certify that the operation <br />described has met the minimum requirements of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made <br />structure(s) in existence at the time this application is filed, and located within 200 <br />feet of the proposed affected area have been identified in this application (Section 34- <br />32.5-115(9)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by <br />law (Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicant/operator, I do not have any extraction/exploration operations in the <br />State of Colorado currently in violation of the provisions of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials (Section 39-32.5-120, C.R.S.) <br />as determined through a Board finding. <br />4. I understand that statements in the application are being made under penalty of <br />perjury and that false statements made herein are punishable as a Class 1 misdemeanor <br />pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this .~_ day of 1//ARcN ~ ~ r~. <br />lvioffat County Road Department <br />If Corporation Attest (Seal) <br />(Operator or C pany Name <br />r ~A <br />Signet;:. <br />Title: Road <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of f n ~i9~Ci/Lf) ) <br />ss <br />County of ~1~`~'_ ) <br />The-f~or~egoing instrument was acknowledged before me this .Z~day of `I~7k/7/~{ ~, <br />by ~IJL'(lflin R _~~nc~ as ~(Kir~ ~S ill7~ `~~v7 of r~~l,K~r,~ ~UL[n G. <br />Notary Public <br />My Commission expires: =3IIZJ.ZOO3 <br />SIGlU~TURES MITST SE IN HLVE INK <br />04/25/97 2823 FC0.112 <br />