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Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the <br />minimum requirements of the following terms and conditions: <br />1. To the best of my knowledge, all significant, vatuable and permanent man-made structure(s) in <br />existence at the time this application is filed, and located within 200 feet of the proposed affected azea have <br />been identified in this application (Section 34-32.5- 115(4)(e), C.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law <br />(Section 34-32.5-115(4)(f), C.R.S.; <br />3. As the applicantloperator, I do not have any extraction/exploration operations in the State of <br />Colorado currently in violation of the provisions of the Colorado Land Reclamation Act for the Extraction of <br />Construction Materials (Section 34- 32.5-120, C.R.S.) as determined through a Boatd finding. . <br />4. I understand that statements in the application are being made under penalty of perjury and that <br />false statements made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this~_ day of .,,,,, <br />• •. o0 <br />,.:• •• ~ <br />Dani Uison ~• Jc" ~';o <br />ApplicanU erator r Company N e If Corporafi ttest ~ ~~ c <br />Signed: ~---~_ Signed: <br />Corporate Secreta uiv <br />Town/City/County Cler <br />Title: Chairman ~ ~~ . ~tj¢li~-c~ ~~ <br />State of Colorado ) <br />County of Routt ) ss <br />The foregoing instrument was acknowledged before m@ this <br />by as of <br />Notary Public <br />My Commission expires: <br />day of_ <br />SIGNATURES MUST BE IN BLUE NK <br />