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' .. <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements <br />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 this <br />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.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-1 li(4)(f), <br />C.RS.; <br />3. As the applicanUoperator, I donor 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.R.S.) as determined through a Boazd finding. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein aze punishable as a Class 1 misdemeanorpursuant to Section 18-8-503, C.RS. <br />Signed and date$ this a S day of ,`~ fJF?~. <br />1~ZSte rnl ~ D~Ji ~e SDU-~~„e,rnl, T+.t. If Corporation Attest (Seal) <br />Applicant/C~perator or Company Name /~ ) ~// C _ <br />Signed: Signed: (~~ ~J . ~~' /i `~ ~{ `~ <br />Title: <br />Town/Ciry/County Clerk <br />State of ~.:d-Go~'lL~a-~ ) <br />~7 ) ss <br />County of ~~ /22.G-6-' 1 <br />The foreg~~o.iyyng~~instrument was acknowledged before nme- this ~~7~ day of <br />by CLGtr ~ ya.~~,~- as ~/_:( ~'~/r/ o ~~ <br />MARGARET F. CASTLEBERRY ~ o~~+,- <br />NotoryPubliC NotaryPu is ~ <br />State of Colorado <br />My Commission expires: ~ ~ z©03 <br />SIGNATURES MUST BE IN BLUE INK <br />