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<br />-~- <br />Certificatioa: <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(9)(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 applicantfoperator, 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 Qato~f£R <br />~~g~~ Go~~Ra~~a~ Go/yljaANy <br />Applicant/Operator or Company Name ' <br />Signed: <br />Title: <br />state of C-o~vR~'4~ <br />_G~R ~~F~ ) Ss <br />County of ) <br />Town/City/County Clerk <br />The fore,~g)oing ins jt~rument was acknowlendged before me this p~_ da/y~of ('J r i. n`c~ ~ r (~, <br />by ~/pA,V ~ -.r V~Al9 as ~1C ~ / Qra/t17 of .(7 ~'Ai~' Ga/~37/lc~c ra.Y~ j'j. <br />~,. „ I.~n ~ll,~. <br />Notary Public p <br />My Commission expires: <~ -~~ ~-9 7 <br />SSGHIfTi/RES MAST SE ID7 SLIIE INR <br />/49 <br />If Corporation Attest (Seali <br />-, <br />/~ <br />Signed: `T.~c I/ ~ /l ~~~ <br />Corporate Secre ary or Equivalent <br />06/26/97 2823FC0.112 V; '• <br />=P 7ERR1 <br />BASHTON <br />