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-~- <br />Certification: <br />As ao mrthari~ed representative of the applicant, I heaeby certify that the opeaation descaibed has met the minimum <br />requirements of the following teams and conditions: <br />1. To the best of my lmowledge, all significant, valuable and permanent man-made strucnrre(s) in existence at the time <br />this application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 3432.5-115(4)(e), CRS.). <br />2. No mining operatiari wrll be located ~ lands where such operatics are prdn'bited bylaw {Settion <br />3432.5-115(4)(f1, C.RS.; <br />3. As the applicmtt/operator, I donut have a~ extraction/explotatic 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.RS.) as determined through a Board finding. <br />4. I ,mdeastand that statements in the applicatic are being made under penalty of peajmy and that false statements <br />made herein are punishable as a Class 1 misd~or pursuant to Section 18-8-503, CRS. <br />Signed and dated this ~--~~ day of t'/L c~® <br />or Camparry Name <br />Sigoed:, <br />Title:~~~.// ~ / o t~ <br />rf Corporation Attest (Seal) <br />Signed: ~~':,G ~w ~ ~~o ~a <br />Corporate Secretary or Equivalent <br />Toam/City/County Clerk <br />State of l_.O~ 0 (~A Ct O ) <br />M (y~ ) ss <br />County of i ' 1d-Cf A-~ ) <br />~foregomg instnrumce~nt w-as ar]meswledged before ~ ~ day of A , d(~C1 ~ <br />bv~l Y)na ~ d l~ c]'~~t el ~ as ~ ~i Ce ry-~~ c~ P y~~- of o ~ C, <br />. -, ,' <br />,~'' - <br />-~` <br />- Notary Public <br />.~~-, - - <br />::~ ;~-~,,~.r= ~ ~' My Co~issiar< expires: Oto <br />SIGNATURES ,tiI[IST BE IN BLUE INI: <br />t.~:~~~ „z as t,a,saa» <br />