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-~- <br />CertiScation: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum <br />requirements of the following terms 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 applicafion 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.S J. <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/explorafion operaflons in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extracflon of Construcflon 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 aze punishable as a Class I misdemeanor pursuant to Secflon ] 8-8-503, C.R.S. <br />Signed and dated this ~ day of ~IYBe'.oix ~ ~90 Z <br />/~ /, ~~p\L~ ~~ <br />LI~~QSTS ~ pC- (~ cr~ure ~ Ly~ .SNP ~ 03 <br />ApplicanUOperator or Company Name <br />Signed: <br />If Corporation Attest (Seal) <br />Signed: <br />Title: ~ j-G~'t-v~P~ <br />State of <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />ss <br />County of ,un7tet- ) <br />The[~~or~e~~7oing inst~p//ent was acknowledged before me ~~ day of , a ~2 <br />by pCIUQ_ ~.. ~d~C,t~T as BBY/tUt~ of ~ ~L <br />~ v <br />om.: <br />p~®8.~~;.p~ Notary Pub <br />,y~~'~~OF COV®~P` My Commission expires: `/"'~~ -py` <br />•nl,.,....,.,a•• <br />SIGNATURES MUST BE IN BLUE INK <br />M:WiPTBDCVdWFORMS~2823C012APP ]OA7/01 <br />