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ii: <br />- 7 - <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 [he 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.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section <br />34-32.5-115(4)(f), C.R.S.; <br />3. As the applicant/operator, I do not have any extrac6on/explora6on operaions in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extracfion of Construction Materials (Section <br />34-32.5-120, C.R.S.) as determined through a Boazd fmding. <br />4. I understand that statements in the application aze being made under penalty of perjury and that false statements <br />made herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this Q~h day of Oc~p{~t~ , <br />'t~2G' 'E5 ~D.~TnC <br />App icant/Operator or Company Name <br />Signed: \\ \ ~ ~'N <br />Title: I~r291 d 2I1~ <br />State of <br />ss <br />County of <br />The fo going instrumentw/as/acknowledged <br />by ~/~~ . ~~ ~/~W-f' as <br />Signed: <br />Att~dt~a~ ~ <br />'Id3S <br />3lvaodaoo <br />/~ss:s~F Corp~rsfe-~.~r~eFr~}+orEquivalent <br />Town/City/County Clerk <br />thisZ ~ day of , <br />~P~S/~O.d7~ of <br />_tABY PUe_ ~D. ~ ~L•UC <br />RHONDA J. <br />OLSON <br />f'•• fp" Not`ary Public U <br />9rF OF •CO~~~~ '' // <br />My Commission expires: -`(-~~'d <br />~~ <br />SIGNATURES MUST BE IN BLUE INK <br />M:NIW~BIX.IMA'PORMS~2823C012.APP 10/17/01 <br />