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. RZClS4 81/31!2008 02:6iP <br />4 of 4 R 20.00 D 0.80 8fi1t8tIRA J MSCO PRRK CO <br />., <br />_ ~ _ <br />Certifkatios: ~~ ~, \j, <br />As an authorittd rcprrsentative of the applicant,! hetsby certify that the operation described has ma the minimum <br />requirements of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and pemument man-made structure(s) in existrntt az 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-I I5(4xe~ C.R.S.). <br />2. No mining operation will be kxated on lands where such operations arc prohibited by law (Section <br />34-32.5-115(4x!), C.R.S.; <br />3. As the applicant/operator, l do not have any exttac[ionlexpioration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction MateriaLt (Section <br />34-32.5-120, C.R.S.) as determined through a Board finding. <br />4. [ understand thst statemenu in the application are being made under penalty of perjury and that false statemenu <br />made herein arc punishable as a Clan 1 tnisdenteartor purattant to Section 18-8-503, C.R.S. <br />Signed and dated this ~ day of 7`..ov/. 2 000 <br />Applicant/Operator or Company Name <br />Signed: <br />Title: P~.Gs.~,e7it~ <br />state of ~-t/ (b 2 Q CI O 1 <br />n )u <br />County of r ~ (~ _~~1 <br />The foregoing ins}S~utttent was ecknowledgod <br />by ~~b22f"(.Cl.2ll~Paes~r°2 es <br />Signed: <br />Corporate Secretary or Equivalent <br />TownlCitylCounty Cleric <br />methia~ / s~dayof qn ua 2 v ~aC <br />t ~ <br />4r•,5~,c.•~.. T~ <br />.,.. ~ ~:r',:.,* .C.~ <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />if Corporation Attest (Seal) <br />M11@16r1APP~VSr'OA3~rl7XOl1./~R OtIlUi99 <br />