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<br />~~ <br />-~- <br />Certification: <br />As 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 best 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 18-8-503, C.R.S. - -- -- - - - <br />Signed and dated this ~ day of s/g~~~1~e.~ 177 . <br />GvCrJ~r/ /~•b~lc , /~/o''ri'Zrn ,-1~tC <br />Applicant/Operator or Company Name <br />Signed: ~l ` <br />Title: ~ U~CC -~/'c ~i c2~ <br />State of C~LO~x~['J ) <br />/ ) ss <br />County of Gti /~/.~ ) <br />The <br />by <br />If Corporation At <br />Signed: <br />(Seal) <br />tary or Equivalent <br />Town/City/County Clerk <br />tknowledged before me this IO day of ~QC.~-,.r~~nfr'e~-p~,~, «F7, <br />Notary Public <br />My Commission expires <br />l v - 3 -~u~ <br />SIGNATIIRES MAST 8E IN HLIIE INK <br />06/26/97 2823FCO.112 <br />