Laserfiche WebLink
-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 the best of my knowledge, all significant, valuable and pennanentman-made structure(s) in existence at Ute time <br />this application is filed, and located within 200 feet ofthe proposed affected area have been identified in this application <br />(Section 34-32.5-1 l5(4xe), C.R.S.). <br />2. No mining operation will be located on ]ands where such operations are prohibited by law <br />(Section 34-32.5-I 15(4)(f), C.RS.; <br />3. As the applicant/operator, I do not have arty extraction/expiorationpperations in the State of Colorado currerttly in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Constmction Materials <br />(Section 34-32.5-120, C.R.S.) as determined through a Boazd fmding. <br />4. I understand that statements in the application aze being made under penalty of perjury and that false statements <br />made herein aze punishable as a Class 1 misdemeanor pursuant to Section I5-8-503, C.R.S. <br />This john has been approved 6y the Mined Land Reclarrration Board pwsuam to section 34-32.5-112,0 R.S., ojthe Colorodo Lam! <br />Recamotion Actjor the Earaclion ojConstraction Materials. Arty aheratian or modifuation ojthis jorm.shoB result in voiding any <br />permit issued on-tire ahered or modified jorm and sabject the operamr to ceace and desist orders and civil penalGiec jot operating <br />withoat a permit parsaant ro section 34-32-123, C.RS. ~~ ' - <br />Signed and dated this ! ~_ day of ffT ~ l ~+- c?c~ Z_.- - "~-~ <br />Albert Frei and Sons. Inc. <br />ApplicanUOperator or Company Name <br />Signed: ~i~.n ~/" ~ ~ ~~ Q <br />Title: CEO <br />_~~ <br />If Corporation Attest (Seal),;`-. <br />Corporate Secretary or Equivalent <br />State of Colorado ) <br />ss. <br />COUnty Of 11 rlnma ) <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this _.1_~ day of I ' N `~ Z Q (7S, <br />a by Albert R_ Frei as CFO of Albert Frei and Sons_ Inc_ <br />platy Public <br />My Commission expires: f ~ U 0 _ <br />SIGNATURES MUST BE IN BLUE INK <br />M:4nio~aLam\v~ ~mr\Cmn[rvRian I12.doc (O7Q8/2004) <br />eenseaa <br />DOREENA G. ARKS <br />NOTARY PUBLIC <br />STATE OF COLORA00 <br />My Commission Expires 1120/2005 <br />