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7 �cCE1VEd <br /> 2,9 1999 <br /> Certification: APR ��Ge0w9`1 <br /> ,nega <br /> As an authorized representative of the applicanty,.�;3Qh�reby 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 (4) (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 34-32.5-120, 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 d3 day of ///A/4L 1 9T . <br /> Moffat County Road Department If Corporation Attest (Seal) <br /> Ap icAnt/Cperator or C pany Name •,,,,,,,,,,,,, <br /> •,•,r <br /> Signed:. Signed: ,e �.� .l '.•' J <br /> nni on <br /> Corporate S ; et y, r ECq�uivalent <br /> Title: Road Supervis Town/CLty/Coun'Ckl('k <br /> State of (b xI9 ah) <br /> ss „r <br /> V County of ) <br /> The foregoing instrument was acknowledged before me this ��day of /�/ �Cu7/�f , <br /> by �IJC�fI(11/'� R _1�-,now as T WA 1_S' pr)0Ln�) of Y�/K�r,� �C(nC4 <br /> Notary Public <br /> My Commission expires: <br /> SIGNATURES MUST BE IN BLUE INK <br /> 04/25/91 2923FCO.112 <br />