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<br /> <br />Certification: <br /> <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements <br />of the following terms and conditions: <br />1. To the best of my lmowledge, all signiScant, valuable and permanrnt man-made structure(s) m existence at the time this <br />applicauon is filed, and located within 200 feet of the proposed aH'ected area have been identified in this application <br />(Section 34-32.5-1 I~(4)(e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section 3432.5-115(4)(f), <br />C.RS.; <br />3. As the applicandoperator, 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 Conswction Materials (Section <br />34-32.5-120, C.RS.) as determined through a Board Ending. <br />4. I understand that statements in the application are being made under prnalty of perjury and that false statements made <br />herein aze punishable as a Class 1 misdemeanor ptusuant to Section 18-8-503, C.RS. <br />Signed and dated this / ~ -tr`. day of ~y b it u n rv ~ C)o ~ <br />Washington County Road 8 Bridge Dept. <br />'ssioners <br />Apphcan erator or omp y ame <br />Signed: ~ G ~~L- <br />Title: x( .~~ ~rw~a~a'~/-~ <br />State of Colorado ) <br />ss <br />County of Washington ) <br />If Corporation Attest (Seal) <br />.,~~a, <br />Signed: ~ nc~'n•r~ ~ 1 t1 ~~. <br />t <br />Corpocafb SeGrctary of~iivalent <br />Town/Citx ounty ~~rk; ; , <br />~. <br />,~' .. ' <br />t; (J ~; "~ <br />~, . <br />//y A <br />The foregoing instrument was aclmowledged before me this ~~ ' day of ~ Oo ~ , <br />by ~u~i,7rn1 E. IlF),JeF as ~'o~~UTy/~Oihnri53inN~r~f I.cJA k/ N6T'oAl <br />~pTA9 v2 <br />-©- ota ublic <br />,~~ Q L~Gna My Commission expires: O~ <br />:Fnc r.;t 0`~ <br />SIGNATURES MUST BE IN BLUE INK <br />