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- ~~- <br />Certification: <br />As an aulhaved represeatmive of the applicant, I bereby certify that the opeaatian desca~bed has met the minimum . <br />requirements of the following terms and canditioms: <br />1. To the best of my knowledge, all significant, valuable and permanentman-made structure(s) in existence at the time <br />this application is filed, and located within 200 fed. of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(4)(e), CRS.). <br />2. No mining operation will be located ~ lands whcee sudr operatics are prohibited by law (Section <br />34-32.5-115(4xf), CRS.; <br />3. As the applica<ttloperator, I do not have a~* ea~raction/exploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Ad for the Extraction of Canstrudion Materials (Section <br />34-32.5-120, C.R.S.) as determined through a Board finding. <br />4. I rmderstand that status in the application ace being made ceder penalty of perjury and that fa]se statements <br />made herein are punishable as a Class 1 misd~ar pursuant to Section 18-8-503, CRS. <br />Signe/d and dated this ` ~ day of ~f <br />/~6CZ/IhS ~~ ~- R 1/ /~.rk ~ .C..LC <br />AgplicaatlOperator ~ Company Name <br />Signed: y,-- <br />Title: ~ /R,rl•t.4in/S. fttr-72nrC.^ <br />if caapaaation Attest (seat) <br />Signed: <br />Corporate Secretary or Equivalent <br />TownlCity(County Clerk <br />me this 1 1 /. day of <br />~ ~~~ <br />Notary Public 'Q ~ 7~-~ <br />My Commission expires: U ~ ~ IU I <br />SIGNATURES MUST BE IN BLUE INK <br />as:~rnaen~.~c~um~tzax paurmop <br />State of L_L1.YJ `lU~ ) <br />