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<br />-~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum <br />requirements of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence a[ 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 34-32.5-115(4j(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations aze prohibited by law (Section <br />34-32.5-115(4)(f), C.R.S.; <br />3. As the applicanUoperator, 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.R.S.) as determined through a Boazd finding. <br />4. I understand that statements in the application aze 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 ~ day of 4}1r3U~7'J'/3EX . ~O 11 <br />L~is~ly7 /~A.iJ ~.t/citc~ ft~~ ~/11j'/r~ ~j ~ `Cf Corporation Attest (Seal) <br />~rrApplicanUOperator or Company Name <br />Sig[ted: ~ - <br />Rma•~'" G <br />Title: ~QR ~S i 7~ +`l~~ <br />Signed: <br />State of ~~I Clr QdL~ _ ) <br />ss <br />County of GU v~41 t~5(`~fl ) <br />Corporate Secretary or Equivalent , <br />Tawn/CitylCounty Clerk <br />The foregoing instrument was acknowledged before me this ~_ day of ©/fP/71 hPY~ , ~, <br />by~Cx`~t L'O'~Pt"1 as nC~'tQV'~t 'P(AI[3~lC of ('~li~fCl~c'ln <br />expires: ,~ r~ <br />SIGNATURES MUST BE IN BLUE INK <br />N'~huMSHARE~VSFORMS282iCO12.MP oviorov <br />