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• .,;ECEIVED • <br />MAR ~ x_2000 <br />& Geolo9Y <br />Certification: ,,tvl5ion of Mt~ra~ <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, ali significant, valuable and permanent man-made structure(s) in existence at the [ime <br />this application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-1 l5(4xe), 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-I 15(4)(E), 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 applicat'son aze being made under penalty of perjury and that false statements <br />made herein are punishable as a Class I misdemeanor pursuant to Section 18-8-503, C.R.5. <br />S~ <br />Signed and dated this day of M,~Rr N . `24 Gb0 ` <br />A. Coti1GR~7'~ Cotl57'K.ucTioN <br />[f Corporation Attest (Seal) <br />Applicant/Operator or Company Name <br />Signed: <br />Title: ~+ESIr7~hfT' <br />Signed: <br />Corporate Secretary or Equival nt <br />State of C.oI0YL1d0 1 <br />ss <br />County of ~2Sq ) <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this ~ ~ day of MA2Gl~{ , 2,000 . <br />by MA~TItJ AZGAtzR.o,(,,A as PRir^StD~r.1T of M.A. Gat1G2GT~ Cpt157QUG'(/(~J <br />- % ~ Notar~ Public <br />Q~ <br />~. <br />> !; ` ti <br />_ My Commission expires: ~O' • 2~ <br />~ n,,,, ^-- - . <br />SIGNATURES MUST BE IN BLUE INK <br />MlMINISHARk1V5FORMS~3671COlI.TPP OLIO/99 <br />