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<br />-~- <br />Certificatioa: <br /> <br />Aa an authorized representative of the applicant, I hereby certify that the operation <br />described has met the minimum requirements of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made <br />structure(s) in existence at the time this application ie filed, and located within 200 <br />feet of the proposed affected area have been identified in this application (Section 34- <br />32.5-115(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by <br />law (Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicant/operator, i do not have any extraction/exploration operations in the <br />State of Colorado currently in violation of the provisions of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S.) <br />ae determined through a Board finding. <br />4. I understand that statements in the application are being made under penalty of <br />perjury and that false statements made herein are punishable ae a Class 1 misdemeanor <br />pursuant to Section 18-B-503, C.R.S. <br />Signed and dated this Zyfti day of ~~~y , /99.6 <br />O LACKS ,~/~JS CUwG/'LTL ~J If Corporation Attest (Seal) <br />Applicant/Ope~/r/ator or Company Name <br />signed: J // ~ ~J W~>- si ~ - Qom, <br />Corporate Secretary or Equivalent <br />Title: ~~.r~.-..~. Town/City/County 'Clerk <br />State of ~ y.~ 6 Q ,( prJ ) <br />se <br />County of _r~ ~ A m ~ ) <br />The foregoing instrument was acknowledged before me thie~N rNrN .day of S U L,`{_ l~l~ <br />by ~ C~ N U 1.- O Cil ~ n S ae -1" Y(C P S ~ Q r i. of (J C,U e r 5 $ RoS C-a ,. <br />QR.IXu 'b1 ~O..A.~-~1~- <br />R„r~ )~, • Notary Public <br />_ ~ Ny Commission expires: la.~ 7_~'!~f <br />SIGNATURES MUST BE IN BLUE INB <br />01/02/96 28?3FC0.112 <br />