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-~- <br />Certification: <br />As an authca'ized representative of the applicant, I hereby certify that the operation described has met the minimum <br />requiremearts of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and pemranentman-made structure(s) in existence at the time <br />this application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34-32.5-115(4)(e), C.RS.). <br />2. No mining operation will be iacated on lands where such opaati~s are prohibited bylaw (Sedi~ <br />34-32.5-115(4)(1), C.RS.; <br />3. As the applicant/operator, I do not have any eaaractionJexploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Con_ struction Materials (Section <br />34-32.5-120, C.RS.) as determined through a Board Ending. <br />4. I understand that status in the application are being made mtdea penalty of perjury and that false statements <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, CRS. <br />Signed and dated this ~ ~ day of ~r~ ~" <br />/~t~a~n,s ~~~- RV /`~.-k, .CSC <br />u0A /02 y ~51~.~5 ~R..-7avrr'S' <br />Applicant/Opceator mCompany Name <br />Signed: ,~/J i,-- ~ / <br />Title: ~" /Rr12 in/S. iai ~-T/v'~i` <br />a <br />/ M <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />TowulCity/County Clerk <br />pm~e~thigs 1 dayy~.of~ D~ Y]Y + 1 ' ~ l <br />.f ILI~M1kk~n LI Ill ~iif j~~ LLJ~I <br />~<;E HAMM <br />Q~;~`'pTg99o,~ r <br />~ i-', CLm <br />ei <br />Nil. ~ O Notary Pubfic <br />y~~:o(~BL~G:PP ~ l~~ <br />O~ ~®~~ My Commission expires: <br />SIGNATURES MUST BE 1s'Y BLUE INK <br />nt ~~w~ uza~ paurzaon <br />State of LJJ_YJ' LU /.~ / I ) <br />