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-~- <br />Certification: <br />As an authorized representative of the applicarn, I hereby certify that the operation desaibedhas metthe minimtmrrequir~s of <br />the following terms and conditions: <br />1. To the best ofmy knowledge, all significant, valuable sad permanent man-mask strtrctrue(s) in existence at the time this <br />application is filed, and located within 200 feet of the proposed affectod area have been identified in this application <br />(Section 3432.5-115(4)(e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 3432.5-115(4)(f), C.RS.; <br />3. As the applicant/operatm, I do not have arty ermactian/exploration operations inthe State of Colorado currently in <br />violation of the provisions of the Colorado Land Recimnati~ Act fot fire Exuacticn of Construction Mateaisls <br />(Segion 3432.5-120, C.RS.) as d through a Board fmdirrg. <br />4. I rmderstand that statements in the application are being made under penahy ofperjruy a~ that false stateo~afs made <br />herein are punishable as a Class 1 misdemeanor pursuant m Section 18-8-503, C.RS_ <br />TRis jorm Afar beat approvrd by arse Mured land Radwna6on Board pwxamrt w section 34-32~111,GRS, ofMre Colorado Land <br />Redaatali~ Aajor abs Em+acrion ojCo~rrbar Ma4rialr. Any abkroaiaar ~ ojU~jae, s,iraIInasn6t,w saidOrg any <br />permia irsned on flee aCered ornrodifiedfornr andsabledtlee operatorto cease and derisaord<rs and dvIIparaaiuforapaINorg»~kard <br />a pernAtpxrsra>ilo sariaw 34-3123, C1LS <br />Signed and datedthis /S~ day of ~~ea moo <br />Benson Brothers <br />Applicant! ar Campmry ame <br />Gck.GL'.Y' XJ. n~~~7 <br />Signed: - <br />Title: Owners/Partners <br />State of Colorado ) <br />ss. <br />Cow, pf Delta 1 <br />Corporate Secretary of Egaivaient <br />Trnvn/City/Cowriy Cleric <br />The foregoing instrument was arlmowledged before ~ this ~ day of ~ r'reH ~G . by <br />~-fC~f/l/llr,,~~~'II~~IJ~•~~~~/~e~ns_a-.~f'~,,,, as Qu)lv~~~8s~~{nrrs of rS <br />/Lr~MNQ /cC_. ~•~J1'~/°`- ``,`ll:itlu.uunC/~ <br />S: v °~ '_ otary Public <br />Q ~ ~ ~ ~ ~ G ,` 1Ky Conrmissi~ expires: ~ <br />If Corp~ation Attest (Seal) <br />Signed: <br />.c <br />SIGNAES Mlh§~ $E IN BLUE INK <br />//Olpllpil~~~~ <br />M:~1~Imdvsf~aYJoo>rrmm rl2doc (07/J8126D6) <br />