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-~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation descnbed has mct the minimum <br />requirements of the following teams and conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at 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 34-32.5-115(4)(e), C.RS J. <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section <br />34-32.5-115(4xf), C.RS.; <br />3. As the applicant/operator, I do not have aiy 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 ands penalty of perjury and that false statements <br />made herein are puniQshable as a Class 1 misdemeanor pursuant to Section 18-8-503, CRS. <br />Signed and dated this " ~ day of V" low Zc~o 3 <br />JE't"r ~ MQ-oi 4 / ~cA I ~ Tr.O ~,.~~, c ~ C'1 If Corporation Attest (Seal) <br />Atmlicant/(Jaerator or C.o env Name o/ <br />Signed: <br />Title: <br />Signed: <br />State of l.~N.C/t U1lG,w 1 <br />'d~D',~ )ss <br />Countc•of lA/~ 1 <br />The f°~°~g instrimment was acknowledged <br />by ~1_~ ~~ as <br />N~s~'AVB1-~G: a <br />,~ OF •COLG•~; <br />Yy Coaunission F~yires ~~ <br />Corporate Secretary or Equivalent <br />TownlCity/County Clerk <br />day of , ~, <br />of - YWltm ~~T <br />h <br />Notary Pubiic <br />My Ca~ission expires: <br />SIGNATURES iVIITST BE Ii` BLUE INI~ <br />m ~~~w~ iiaa« oonsnmi~ <br />