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<br />-~- <br />Certification: <br />As an authorized representaflve of the applicant, I hereby certify that the operafion described has met the minimum <br />requirements of the following terms and conditions: <br />1. To the best of my lmowledge, 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.RS.). <br />2. No mining operation will be Iocated on lands where such operations aze prohibited by law (Section <br />34-32.5-I15(4)(f), C.R.S.; <br />3. As the applicantloperator, 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.R.S.) as determined through a Boazd fording. <br />4. I understand that statements in the application aze being made under penalty of perjury and that false statements <br />rnade herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this ~ ~~ day of '~Z'~ttV, , 7 c~c~ L <br />Grand Junction Pipe F, Supply Co. <br />If Corporation Attest (Seal) <br />Applicant/Operator or Company Name <br />Signed: ~~.v <br />>> <br />Title: Marie Tipping, President <br />Signed: ,/,G~dr~n ,(1/ OA,LCi.~i/ <br />/ Corporate Secretary or Equivalent <br />Town/CitylComiry Clerk <br />State of Colorado ~ -- - _ "~ ~ = -_ <br />County of Mesa jss ~- '~ ',\` <br />.r ,, ` <br />~?„ ` %:? <br />The foregoing instrument was aclmowledged before me this l ~~ day of ~layc.L< n~ ,~-~ Z. , <br />by~~zatic Ti :.,~ as ~.-~'l~c~.~~ of6v1 ~1~~~n ~P~~a~ ~ESvro~~ <br />No[ary P lic - <br />My Commission expires: ~~./05~0~ . .~~_ <br />SIGNATURES MUST BE IN BLUE INK <br />M:NIQT~BDCIMINPOILMS~2823C012.APP 10/17/01 <br />