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.. I <br />Certification: <br />7- <br />As an authorized representative of the applicant. I hereby certify that the operation described has met the minimum <br />requirements of the fo-lowing terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence a[ the time <br />this 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.R.SJ. <br />2. No mining operation will be located on lands where such operations aze prohibited by law (Section <br />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 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 J as determined through a Board fording. <br />4. I understand that statements in the application aze being made under penalty of perjury and that false statements <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this 1 g } h day of Feb r C ` .Z. C.1D~_ <br />M.A. Cloncre><G /.oa5'7rUG~%O/1, Znc. <br />ApplicantlC+perator orCompany Name <br />Signed: <br />Title: f~-~S~CIe.~f <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary• or Equivalent <br />Town/City/County Clerk <br />State of C'o /ora d o ) <br />~~j ss. <br />County of n//P$Q ) <br />The foregoing instrument was acknowledged%b~efore me this ~rh day of ~~!/`/Ud t' N , ~/. , by <br />Ma/~i/7 AZLOr~-C~aGt as /~issiC/erlf of M. R • LonC~E>~z°~(o~sfrvcTOn~Ti~~• <br />_, s - - <br />_ -' ~ ~ ROBIN D• i No ary Public <br />:~ t g~EVENS <br />_- <br />.• <br />My Commission expires: t!o - I a - o~ CUcJ <br />~t~y <br />- - 9jw•.....r <br />BE IN BLUE INK <br />M.\minl~here\vsfortns\Cmsswction 712.dac (10/IS/2001) <br />