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-~- <br />Certification: <br />As an authorized representative of the applican [, I hereby certify that the operation desc+ibed has met the minimum requirements <br />of the following terms and conditions: <br />I . 'fo the best of my knowledge, all significant, valuable :urd permanent man-made snveture(s) in existence at the time <br />this application is Sled, and located within 200 feet of the proposed affectul area have been identified in this application <br />(,Section 34-32.5-I 15(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations arc prohibited by law <br />(Section 34-32.5-I l5(4)(f), C.R.S.; <br />3. As the applicant/operator, I do not have any extraetionlexploration operations in the State of Colorado currently in <br />violation of the provisirnis of the Colorado Land Reclamation Act for the L:xtraction of Consnvction Materials <br />(Section 34-32.5-120, C.R.S.) as determined through a Board finding. <br />4. i understand that statements in the application are being made under penalty of perjury and that false statements <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />7hls forth has been approved by Nre blued Land Reclamation Rnnrd pursrrm+t to section 3442.5-11$C. R.S., of the Colorado /_nad <br />Reclaoraiinr+ Actfor theFriractiun ofCnnstractton MatcriaG. Any alterntiar or modiJlention oJ'lhisform shall result in vaidb+g any <br />perneit issuer/ nn the altered or modified form and ,wrbject Uie operator to cease and desist orders and civil pennhles jot operrrriug <br />ruirlmat a perrnitparsuant to seclfon 34-32.5-113, C.R..S. <br />Signed and dated this _~ day of _~~r~ 4[ S ~ °~~o z <br />E-~7a Peer, ~ 1~~~6wr~c~ __ At,-!~ ,l,.,M-; ~y <br />ApplicanUOperator or ComApa`n\y 1Q~me <br />Signed: ~ / t\ ~l-~~~~.~ <br />'title: ~!~~(' EW ~ v ~ ~ i ~ ~C~t, <br />Stateof_ ~ofdd0 ) <br />ss. <br />Countyof~~~P-('lO~- ) <br /> <br />The foregoing inshument was ack»owledged before me this ~~ day of__C-t U <br />~~, by ___~ W~?r~ J .__Dp (, pz(Ft~ as _~1~~~~y L fll fec~u/ <br />'towrJCity/County Clerk <br />- - ~- - - <br />DIANE LUNDQUiST <br />NOTAFY PUBLIC Notary public <br />STATE OF COLORADO <br />My Commission Expires 0 911 9/2 0 0 7 My Commission expires: l`~ ~ 2.00 <br />SIGNATURES ]4TUST BE IN BLtIF, INK <br />If Corporation At[es[ (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />41+ininkhureh~srum~tiC'onznu&m n"Likm (Approved 05!1112605) <br />