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• 392439 08/08/2 0 12:30P 8803 P48 pPP <br />_ ? B of 32 R 0.00 D 0.00 Elber'! County CO <br />Certification: <br />As an authorized representative of the applicant, 1 hereby certity that the operation described has met the minimum <br />requirements of the following terms and conditions: <br />I . To the best of my knowledge, 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 34-32.5-1 I5(4)(e), C.R.S.). <br />2. No mining operation wit! be located on lands where such operations are prohibited by law (Section <br />34-32.5-I I5(4)(f), C.R.S.; <br />3. As the applicant/operator, I do not have any extraction exploration 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.R.S.) as determined through a"Board finding. <br />4. 1 understand that statements in the application are 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 ~~~ day of .-~~/'` ~ ~"c~ <br />f~ <br />If Corporation Attest (Seal) <br />Appli UOperator or C any Name ~quurruuu <br />.~~`s~aER T ~rr4,, /7 ~~ <br />r y ~~` - <br />Slgned: J~~LC...~nn F 1'~ur v`t.{ ~ *e• • $ <br />-CCt ~ <br />A rpoBtte ecreta or Equiva~ <br />Title: C ~~ c~;~^,,.,~r~.~ n : o ~O~ L :°*gown/CitylCounty Clerk <br />State of G••1ocq.L~Cr ) q~~~r(rQrR'ArDO1````\`\~. <br />ss <br />County of ~. 1 ~.e ~ ~ ) <br />The foregoing instrument was acknowledged before me this ~~ day of ~~ ( ~'~ , <br />, <br />by l.:r,.,n,.P Q,er~~~1 as~~ .c ce.~. of ~l~S~v-F C~•-~.~~-, <br />-~ ~-~ P L/ - ~t,.cr.~ 1 n-~' Ccoc-~-.,~ t ~ C~,..~.~~SS ~i <br />z; GERHpF~t•: I <br />P' g01.~tG ~ ;' Notary Public <br />''. -~ ; <br />,••~ ~ <br />~~~~ Or CO~yi <br />My Commission expires: ~ - I I-~-a~l <br />SIGNATURES MUST BE IN BLUE INK <br />M:N9t.'ISHARFVSFORM5~2973COliwPP 07/10/99 <br />