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-~- <br />Certification: <br />As an aniharized representative of the applicant, I hereby certify that the operation desrnbed has ~t the minunum <br />regair~ of the following terms a~ conditiems: <br />1. To the best of my knowledge, all significant, valuable and permanentman-made strucdue{s) in existence at the time <br />this application is filed, and located within 200 few of the proposed affected area have been identified in this application <br />(Section 3432.5-115(4)(e), CRS.). <br />2. No mmiag operation wll be located on lands where suds operations are pmiubited by law (Section <br />3432.5-115(4~f), CRS.; <br />3. As the applicant/operator, I do not have a~ exlraction/exploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamati~ Act for the Extraction of Construction Materials (Section <br />3432.5-120, C.RS.) as determined through a Board finding. <br />4. I un~stand that status in the applice>iau are being made ands penalty of perj~y and that false statements <br />m~e herein are pmzisbab~ as a Class I mar pursoaat to Section 18-8-503, CRS. <br />Signed and dated this z 2n r r! day of ~.c<.~. aGtz <br />If Corporahicn Attest (seat) <br />signed: <br />Title: <br />State of ~ r6-~a ~~ 1 <br />ss <br />County of LSOn~ <br />signed: ~ / / (1~ <br />~¢~iaZe-.~ rate Secretary or Equivalent <br />Town/City/Camly Clerk - , _ <br />-~ s~ <br />The g insavment was admowledgeti bef this -2 2 h ~ day of ~,r 2oC~ 3 , <br />by ~2 ,e. Cl~2t o~ as ~r~tY.teceaP~tf'/G~¢a~~, o ~iner~ o~ti~.o - ~veQ~ s9~e, <br />_ a`( P a, <br />~: BARtIAI'A S. ~~ <br />SUDERMAfi3N <br />~. ~ Notary Public <br />~'•. <br />\ ~~`' `~~~~ My Commission expires: ~gto-Qit~9~ aGoS~ <br />SIG1V'ATURES MUST BE IN BLUE 11VI: <br />M:1~VLaeh~K',a tl2.aac «aisrmoi~ <br /> <br />Rc~~a~ ~~~s ~et~S-- c,3c~ ~ Imo, <br />