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• <br />Certification: <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 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-I 15(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 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.) az determined through a Board fmding. <br />4. I understand that statements in the application are being made under penalty of perjury and that <br />made herein are punishable az a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. ~ <br />Signed and dated this ~ day of~.~~ , <br />I(~t~ ~ - <br />Company <br />Title: ~/ /l.iC/ ~~l/CJC!! ~[ / <br />State of ~~-~'LiZ~~ ) <br />If Corporation <br />or Equivalent <br />Town/City/County Clerk <br />~t;1_C'lill 1J ) ss <br />County of ) <br />The~gre$o~g instrument was acknowledged b'/fore this ~_ day of ~ ~ , <br />by~~~S~~~-l C. (~Oll,`JT as U I(;Q, ~Pbl/~kfi~ of ~. ~~ G~(/~ T <br />~pRr pie <br />.. <br />~ Notary Public <br />KIM RNAR~ f <br />My Commission expires: j 9 ~) (~. <br />:~~I~LUE [NK <br />MP OLIQ99 <br />