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• <br />NFC~~~F~ <br />Certification: ~~NSrpnp~ ` I ~ 2Q <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the m?~f~t~ <br />requirements of the following terms and conditions: G~~ <br />1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at 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 34-32.5-1 IS(4)(e), C.R.S.). <br />2. No mining operation will be {orated on lands where such operations are prohibited by law (Section <br />34-32.5-1I5(4)(f), C.R.S.; <br />3. As the applicanUoperator, [ do not have any extraction exploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamazion Act for the Extraction of Construction Materials (Section <br />34-32.5-120, C.R.S.) as determined through a Board fmding. <br />4. I understand that statements in the application are 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 ~9/2 G fi ~O <br />/. /(. Eiv TE/e~/.t°i ~ ES <br />Applicant/Operator or Company Name <br />Signed: <br />Title: /r ~iti. ~1~i~ i'? <br />State of ~~/.,,P.s~/.r ) <br />ss <br />County of 7~(Llr ) <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secret or Equivalent <br />TowtJCiry/County Clerk <br />The foregoing instrument was acknowledged be~f±ore me this f y day of M.4.P~,s~ <br />by ~.QP/rJ /'~V /~. ~O ~p a5 /s Pn. /`9Gn ~Oer Of f /l ~h tii~iit~f ~a~'. <br />`^O~ uu~ , <br />' ~M~ <br />~~ Notary Public <br />7~-19Ay r~ <br />~~ <br />'~bdl~J O My Commission expires: G~,~/~rn~,~L_ <br />~G~R~ IN BLUE INK <br />M:NOMSHARFVSFOHM5~3827COI7.MP OLION9 <br />