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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 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 azea have been identified in [his applicafion <br />(Secfion 34-32.5-115(4)(e), C.R.S J. <br />2. No mining operafion will be located on lands where such operafions aze prohibited bylaw (Section <br />34-32.5-115(4)(f), C.R.S.; <br />3. As the applicandoperator, 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 (Secfion <br />34-32.5-120, C,R.SJ as determined through a Board fmding. <br />4. I understand that statements in the applicafion 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 [his ~ day of ~'/LwX d ~ ` - •, ~ no, <br />_ p~ ^ `~ ~` s-~ ~ <br />L/a~ .ZA~• If Corporation AttesE'(Seal~ ti > ~ a <br />A rc O for or Company Name ~~, ~„" ems' <br />< , <br />Signed: , D f id~~l.LU /'+i'vLi Signed: l~/~~ ~/ -. l G~ . <br />,~,F . Corporate Secretary or Equivalent <br />Title: <br />i <br />Town/Ci[y/County Clerk <br />ss <br />County of _ [~/~ UFn.- ) <br />The foregoing m [rumen[ warms acknowledged before me this ~~ day of ~7LccX , ~, <br />by ~ T(~~cX ~ . X/1~Q ~Q/c~ as ~ ~ o~ ~ <br />LINDA S. BACH <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />My Cornm:esicn Expires <br />My Commission expires: <br />SIGNATURES MUST BE IN BLUE INK <br />M:NIW~BDCNIINPORMSV.823C012.APP ]0/17/01 <br />