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<br />Certification: <br /> <br />-~- <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 si¢nificant, valuable and permanent man-made structure(s) in existence at the time <br />Chis 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 I~(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-I ! 5(4)(f), C.R.S.; <br />3. As the applicantloperator, 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 Boazd finding. <br />4. I 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 I misdemeanor pursuant to Section { 8-8-503, C.R.S. <br />Signed and dated this ~ da of /W~ <br />C~loraa0o «~ 1~~ <br />~~ ~~ <br />ApplicanUOperator or Company Name <br />Signed: ~I~ <br />rt~,E,.y /~~ <br />zh aisfriCf <br />[f Corporation Attest (Seal) <br />/~ ~ ~ <br />~. <br />Sign - ~. <br />~/. ~~~~//~~ ,,,, ~~ Corporate Secretary or Equivalent <br />Title: ../.d~wii / ~~rr-~Fi~.. Town/City/County Clerk <br />State of \ 1`1C.~Y~.t~ ) <br />~;~ ) ss <br />County of __~I X l l Lc~ ) <br />T`l~1fo\reg^omg ins`t'rument was acknowledged b(e~fore me this~n~n-,, day of ~l ~` _, <br />by I I„~L?_X~ll.f,~CC>.,~, _ as 1.~~41"t't(`'~ t y `u-4.Q9,Q h of i~i-ec~ ~ l - 1-I.P Axe ~f'S~yii~ <br />SOW/yS`c `~\~~ <br />OTARtio <br />Notary Public <br />0 G.~O My Commission expires: '~!l~b3 <br />OF COO SIGNATURES MUST BE IN BLUE [NK <br />.,:ewrtistur<~E~yM060t200~~ <br />