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-~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum <br />requirements of the following terms and conditions: <br />1. To the best of my Imowledge, all significant, valuable and permanent man-made structure(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 34-32.5-115(4)(e), C.RS.). <br />2. No mining operation will be located on lands where such operations aze prohibited by law (Section <br />34-32.5-115(4)(f), C.RS.; <br />3. As the applicant/operator, I do not have any extraction/exploration operations in the Slate 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 Boazd fording. <br />4. I understand that statements in the application aze 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 />Signed and dated this ~{th day of ~c-Eo~Y , <br />It~ci~tie5 Co.~t,c. <br />App eTrator or Company Name <br />Signed: \\ l \J~ ~ `N <br />~;(~ <br />If Corp ati At[~`t!5da~ ~ <br />ti '~/3S ; <br />O y' <br />Signed: <br />/{tssf Corp~rsf~.,~ie~orFquivalent <br />Title: 1~r29 i d 2f1t <br />State of <br />ss <br />County of <br />They f°~gomg mstrumentw,as~aclmowledged I <br />by ~//P.~ ~I 7°dl W~ as <br />Town/City/County Clerk <br />~ / day of ~ _ _, ~ ~,_, <br />of ' <br />r P~ ~o , 'mac <br />OLSON <br />J. <br />~`•• ; p" NotSry Public <br />9j;•.., ...•~~. <br />FOf •CO~~ '/ <br />My Commission expires: ~~a'Q <br />urc~a~~e,-~1 <br />SIGNATURES MUST BE IN BLUE INR <br />Murunaocvawroanssvezsrniierr ~omro~ <br />