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<br />-~- <br />Certification: <br />As an authorized representative of the applicant.l 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 permanent man-made structure(s) in existence at the time <br />this application is filed, and located within 200 feet of the proposed affected azea have been identified in this application <br />(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 (Section <br />34-32.5-115(4)(f), C.RS.; <br />3. As the applicanUoperator, I donot have any extraction/exploration 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.RS J as determined through a Boazd finding. <br />4. I understand that statements in the application aze being made under penalty of perjury and that false statements <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this 2 ~ ~ day of (/~~•~~ ,2 O O ~ <br />i/GO/`~IM (/w ,Qys/n.ESS % /1 Us7` <br />ApplicanUOperator or Company Name <br />Signed: ~~/l~~'- ~ ~~..~%~-~"'.~""- <br />If Corporation Attest (Seal) <br />Signed: <br />Title: Wit, e, <br />Slate of L OC~7"~G~`' ) <br />/y p ) ss. <br />County of (7r~cyrGC . 1 <br />Corporate Secretary or Equivalent <br />Town/CirylCounty Clerk <br />The foregoing instrument was acknowledged before me /this ~~ ~~ day of /~ ~~ aoD3 by <br />~~)i~iS /. J(.r. G~iJhh~l Yn aS fl'U,S rP P~ Of C//l ('(l 4n my~~6iti vi2 r.-Q. <br />~:` NOTgRy,y N~ otazvpublic <br />~~ . <br />y AVBLIG.:.p=` My Commission expires: ~ <br />'~, ..... 'P~ <br />''.,. ~Rnn~~OQ.~ <br />IN BLUE INK <br />M \fnin~chsa\vs(orms\Corewction 1 I2.doc 00/15/2001) <br />