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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 requirements <br />of the following terms and conditions: <br />1. To the best of my Imowledge, all siBniScant, valuable and permanent man-made structwe(s) in existence at the time this <br />application is filed, and located within 200 feet of the proposed affected azea have been identified in this apphcation <br />(Section 34-32.5-115(4)(e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section 3432.5-115(4)(£), <br />C.RS.; <br />3. As the applicantJoperator, I donot have any extractionlexploration 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.RS.) 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 made <br />herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this ~ day of ~~tvN,kW ZOO Z , <br />Ct~ o~ Fe-i~GIItNs <br />ApplicandQperator or Company Name <br />Signed: ///RMS.. <br />Title: A.~R~rn.I lfrG[.1 PrD'!(A^i A2on.+y.e!' <br />State of ~G.~OhGG1D ) <br />ss <br />County of ,~i~,si,~ri ) <br />The foregoing instrument was aclmowledged before me this a~ day of ~ S~ ~r ,~ hrh , , oZ0o,2 , <br />~7 -~ <br />by ~'yl~~tk sac~za as IP AiJltra~2t"~/~rnze ~6~ of ~-!~c ~~~i ~7 ;1z~1 ~e,L Let..o <br />-~-T~- r , <br />~~Q~C~E~ P,~a9,~~,~ `~~~~~~~,~,~ <br />~ e. ,eat ~ stah~~-, <br />``~pvvvvQptl d Ot)0 ~~~i~'i <br />.~ O~~O y~ <br />rw <br />0 Tb p. H <br />r b ti <br />N.1pN ~y <br />J ••».....~' <br />~~`ii., b~~ t a id a...~~~~~ <br />Notary Public <br />My commission expires: >a- U(o <br />SIGNATURES MUST BE IN BLUE INK <br />