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-8- <br />Asap authorized representative ofthe applicant, I herebyoertifythatthe operation descnlted has and the minimum requirernerets <br />of the following temrs and conditions: <br />1, To the best of my lmowledge, all sigttifiixrtt, valuable and pemlatteotman-made swcture(s) in existence at the time <br />this applicasiat is filed, and located within 200 feet of the propeeed af1'octed area have been identified iu this appliption <br />(Section 34-325-1IS(4xe), C.R.S.). <br />2. No mining opaalion wi11 be located on where such operations ate prohibited by law <br />(Section 34-325-113(4xf), C.R.S.; <br />3, Aa the applicarttloperator, I do rest have eny extraotiodexpbratioe operetioas in the State of Colorado eun+entty in <br />violation of the provisiom of the Colorado Land Reclamation Act for the F.xwcuon of Consnuctial Materials <br />(Secriorl 34-32.5-120, C.R.S.) as determined through a Board finding, <br />4. I uoderatand tltat statemeuta in the applit~tion are being made under penalty of perjury and chat false atatea»etts <br />made herein are puaiahable as a Clew 1 rltisderneatter plusuaat to Soctiat 18-8-503, C.R.S. <br />Tktr jbnw 6o brew evD~+iy dt<,v4red Load Reelwsaewr Board paraeewt ro aeettow 31-325.112.CR..C. ejdie Coforarlo Lend <br />RsarawuCea.latJWateENixaNswajCowadwmfarA/r~gndalS Myelwrerwe~ardwreJ'alkf8rwairOmwa6r"aLllerpewY <br />oaw&t imra! ow fAe adrered or wol~led fires eel sa6, jsd /Aa eperr<w q arse eed hit erdos eld eios pewees jot opu~l~rd <br />wliiluae a perleBOrrreewt m,aat4tow 3I..i1S-123, CR.,4 <br />Signal card dated this ~' " day of ~~ Zoo 7 , <br />G ~K~t/y D~LL~ ~C~ <br />ApplicanU~~or C~omp~ny Name <br />Signed: ~fF~.i.C~G. ~~~:L!a1'~-- <br />Title. CiCa:,~, C~ Ln .9~.d/.,"f" <br />IfCotpor~iion Attest (Seal) <br />.` <br />~Sn pi <br />Cotporare *Y or E4 . <br />Town/G7ry/Coumy Clerk <br />State of ~~tNo-~ ) <br />)~ <br />County of _ ) <br />The fling instrument was actowwledged before me this <br />! uM~ day of <br />~-, <br />~ ~~~ <br />~ ' ~ oaf <br />!7J Notary Public <br />My Commission expires: -~____ <br />Q `" ` ~ BE [N BLUE INK <br />M:bdtlalme~nw~'4rwNOn I Ir.Os~ppNM 0 <br />