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<br />-~- <br />Certificatioa: <br /> <br />Ae an authorized representative of the applicant, I hereby certify that the operation <br />described has met the minimum requirements of the following terms and conditions: <br />1. To the beet of my knowledge, all significant, valuable and permanent man-made <br />structure(s) in existence at the time this application is filed, and located within 200 <br />feet of the proposed affected area have been identified in this application (Section 34- <br />32.5-115(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by <br />law (Section 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 <br />State of Colorado currently in violation of the provisions of the Colorado Land <br />Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S.) <br />as determined through a Board finding. <br />4. i understand that statements in the application are being made under penalty of <br />perjury and that false statements made herein are punishable as a Class 1 misdemeanor <br />pursuant to Section ie-8-503, C.R.S. <br />Signed and dated this ~_ day of ~l/FJI9l/l1~~ 1//h _. <br />fl'kAQ°Q ~t-5~~4 ~Y~. If Corporati n,~Attest1 (5~1) <br />Applicant/Operator „ 1 <br />signed: c~_i/lr-~, signed: <br />Title: M 7.N.c ~~ <br />State of J.N~/d'//~GL~O ) <br />/, ) ss <br />County of ~.Ct,L~IZ!/ ) <br />(' <br />r- <br />or Equivalent <br />Town/City/County Clerk <br />/K~ <br />The foregoing instrument was acknowledged before me thisr~ day of %/~°~Z~~~l~~ ~. <br />by ~ C,I'~L as ~f.17i~ of ~/////G/2.' ~C/~`1~LC. <br />Notary Public <br />My Commission expires: ~~~/~~ <br />01/02/96 2323F(:O.112 <br />