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:~ <br />-~- <br />Certifications <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 texme and conditions: <br />1. To the beat of my knowledge, all significant, valuable and permanent man-made <br />structure(s) in existence at the time this application ie 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 Hateriale (Section 34-32.5-120, C.R.S.) <br />ae 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 18-8-503, C.R.S. <br />Signed and dated this ~ day of N ~I , ~~~ <br />RT('HARD ULLOM <br />Ap ic~nt/Operator <br />Sign T~ ~ ~'~- <br />>- <br />Title: COUNTY ROAD 'SUPERVISOR <br />If Corporation Attest (seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of f'fll nROnfl ) <br />ss <br />County of RTfI 91 ANf'(1 ) <br /> <br />The foregoing instrument was acknowledged before me this ~ day of ~~ L• '~'•'l, <br />_ % ~` <br />,; <br />by ~ .n', ,V / '/, as ~'/ J ' ~~; of !`F: .,~~. / _ <br />_~ <br />/t c ~ L. c. <br />Notary Public _ , - - . '/ ; <br />!i. .,... ~. ,; ~i. <br />My Commission expires: <br />01/02/AS 2823FG0.112 <br />