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-~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum <br />requirements of the following terms and wnditions: <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)(1), C.RS.; <br />3. As the applicandoperator, I do not 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 fmding. <br />4. l understand that statements in the application aze being made under penalty of perjury and that false statements <br />made herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this ~ ~ ~ day of ~0 <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Egtrivalent <br />Town/City/County Clerk <br />State of l.l~~t~Y Q ~tn ) <br />,(~ ) ss <br />County of~ ~ ~Y~~h ) <br />The foregoing instrument was acknowledged before me this b~ day of , ~rn~ , <br />by ~~o_~.~ee-2~L as~G.rLLa~'C of ~c,~~.hp ~~~ <br />Public <br />My Co \ sion expires:'1 ~ b <br />SIGNATURES MUST BE IN BLUE INK <br />M:\MQi~BD(,UfA'FORMSV.823C012.APP tanioi <br />Title: !/U/ I~~~G7 t~~' , <br />