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~- <br />Certification: <br />As an authorized representative of the applicant, l 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 knowledge, all significant, valuable and permanent man-made structtve(s) in existence at the time this <br />application is filed, and located within 200 feet of the proposed affected azea have been identified in this application <br />(Section 34-32.5-115(4)(e), C.RS.}. <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-1 li(4)(f), <br />C.RS.; <br />3. As the applicant/operator, 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 fording. <br />4. I understand that statemettts in the application are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor ptusuant to Section 18-8-503, C.RS. ~. <br />Signed and dated this ~_ day of /ut° , ~,?DD ~ <br />~~ /,~ <br />/' acv RCN S ~-cu~ci Lrt <br />Applicant/Operator or Company Name <br />Signe <br />Title: <br />Town/City/County Clerk <br />State of C~ I n rGd o <br />ss <br />county of Pr~,.ar~S 1 <br />The foregoing instnrment was acknowledged before me this ~~~ day of rk1~7Y~ 1 , .2vo1 , <br />by ~~hl'I~~.1')'1°CLbI~,-~ aS Ce. Ct4..~IC~ of_ PlJ I..A..^S Co r.~;J-..1 <br />^~' - .' <br />-~ - - <br />_ .. Notary Public <br />_ _ _ httCO~'d1~~08-17-2005 <br />. - My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />ff Corporation Attest (Seal) <br />Signed: ~t <br />Corporat Secretary or Equivalent <br />M:~hhnehYarm~2823C012APP (0 7/1 780 0 0) <br />