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,_ <br />Certification: <br />As an authorized representative of the applicant, I 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 signi5cant, valuable and permanent man-made structure(s) in existence at the time this <br />application is filed, and located within 200 feet of the proposed affected area 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 bylaw (Section 34-32.5-115(4xf), <br />C.RS.; <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.RS.) as determined through a Board Ending. <br />4. I understand that statements in the application are being made under p®alty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this ~_ day of a 0~ ~ <br />i <br />r.ITY OF GREELEY <br />ApplicanUOperato~r or Company Name <br />~ J (~~G'~0-rte <br />Signed: <br />Title: ~GLi~/.a~~ <br />ff Corporation Attest (Seal) <br />Signed: ~ -~ 1~.~ <br />Corpora Secriitaiyor.Equivalent <br />Town/City/County Clerk <br />State of ~n~n~.~~o ) <br />ss <br />County of bt~P /~ ) <br />The foregoing instrument was acknowledged before me this ~_ day of ~~e,~v / / Do , <br />by ~rn.ct~,~,jLy, ~, F4n,/r~ as av.~f~ /~.:,c~l~'~~ of~p.~. ~!;~,d"-Q h~a'Ir~ <br />`~ ~ ~ ~=. <br />Notary Public _ _ <br />Pvly Commissi~r, moires ~pie.~ber i8, 2002 <br />.. :~ J -- - <br />My Commission expires: - ~- <br />-=~ ; ,r ;: <br />~~ ~ <br />SIGNATURES MUST BE IN BLUE INK - ~ <br />