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-~- <br />Certification: <br />As an suthcaized representative of the applicant, I hereby certify that the operation described has mom. the minimum <br />regair~ts of the following terms and canditio~ns: <br />1. To the best of my lmowledge, all significant, valuable and permanentman-made structure(s) in existence at the time <br />this application is filed, and located within 200 feet of the proposed affected ales have been identified in this application <br />(Section 3432.5-115(4)(e), C.RS.). <br />2. No mining operation w~71 be located on lands where such operations are prohibited by law (Secti~ <br />3432.5-115(4j(t), C.R.S.; <br />3. As the applicant/operator, I donut have any extracGonlexploration 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 fording. <br />4. I undasts~d that state~ts in the application are being made under penalty of perjury and That false statements <br />made herein axe punishable as a Class 1 nrisdemeanor pursuant to Section 18-&503, C.RS. <br />Signed and dated this ~ day of `l ~ vcS ~ <br />Appli or Compan Name <br /> <br />Tine: -1..i ~OG'6'i°~~iLd~O~' <br />If Corporation Attest (Seal) <br />~, <br />Signed: <br />Corporate Secretary or quivalent <br />Taws/CitylCounty Clerk <br />State of C~,JIo ra~ ) <br />_ ) ss <br />County of - ~S <br />The fore was acknowledged before 's ~ day of ~ .~Q~/ > <br />by 7 ,rjnL~Zm}eatl~iJ~ as of <br />LILLIAN SANCHEZ <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />Notary Publi <br />My Commission expires: /=j-d 7 <br />SIGNATURES MiTST BE IN BLUE INK <br />M:~~w~~a~ u2mc paisrmop <br />