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- 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 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 idenfified in this application <br />(Section 34-32.5-115(4)(e), C.R.S J. <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.R.S.; <br />3. As the applicandoperator, I do not have any extracfion/exploration operations 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 fording. <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 this 1~` `~ day of ~! kb~CaQ'( 7.C>~2 <br />Cl'k'~e - C~-1~~~ - <br />ApplicanUOpera[or or Co any Name <br />Signed: <br />Title: C,i.o,...,,.~,. lbocc <br />State of W lOr Qd0 ) <br />County of ~(~ t'1'Lt~ ~ ss <br />If Corporation Attest <br />Signed: <br />,. <br />``````1~e~ ~ . <br />.. <br />^: ~`, <br />r, ' ~= <br />~~ .~ v. <br />%" - .' <br />i.,l <br />Teu~dEitq/County Clerk <br />The fo^re~going instrument was acknowledged beforle,,me this g ~= day of ~Gi-oEX,~-' , <br />by CJ~~+-~ L-~ . ~2Lt,[C.lc. as ~,t N,tl(!~VILc.YI of ~Q~fL~Lfll~iJ ~Jf~fR.~4F' <br />CdjYVtIV!-l {onclcs <br />• f '?ice <br />-~ ~~ =~ i <br />-°•-• <br />- My Commission expires: <br />SIGNATURES MUST BE IN BLUE INIC <br />M:~MN~BDCVv1WPORMS12823C012.APP 10/17/01 <br />