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-~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certifi~ that the operation described has met the minimum <br />requirements of the following temvs and conditions: <br />1. To the best of my Imowledge, all significant, valuable and permanent man-made structure(s) in existence aY 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 34-32.5-115(4)(e), C.RS.). <br />2. No mining operation mill be located on lands Rnere such operations are prohibited by taw (Section <br />34-32.5-115(4)0, C.RS.; <br />3. As the applicant/operator, I do not have any extraction/expIoration 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.) as determined through a Boazd fording. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statements <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section 15-8-503, C.RS. <br />Signed and dated this ~ ~ c~~ day of 1) ~= C. r l~n ~3 GiZ, , ZOO-L <br />/'~~ R ~=-~ ~ i i~ 1- N O (~ 5 i ~? i +-S - (/v C K ~ ~N ~ . If Corporation Attest (Seal) <br />Applicant/Operator or Company Name <br />-, ~~,, <br />Sign ` --~- Signed: ~ ~; -,. ^-/~'~ `!i_ <br />~W Corp ate Secr~tazy,-'or E-quivalerrt <br />Title: ~ yet=(~2~~ D ~T Town/Cit~G2imty'-_Cler~^ <br />. `S <br />~ - =.-`: <br />o, ` ~ a ~.~. .,,~ <br />~_-~;~. <br />State of ~~~tJte ~m-~ ) (f! " - ~;, <br />ss <br />County of ~ ) <br />The f[o~regoing instrunment as acknowledged before me ,tom/ /Y~i day of ~~O.in~2K , aoa2 , <br />by / f.lC~IGLO-Q C~• as ~~.CC.P ~"Ji2.CQoPmc{' of ~~9~ ~ir~iia. _ 1~(/~~. ~Ic• <br />My Commission expires: <br />oan snoaz <br />