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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 conditions: <br />1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the <br />time this application is filed, and located within 200 feet of the proposed affected area have been identified in this <br />application (Section 34-32.5-1 IS(4)(e), CR.S.). <br />2. No mining operation will be located on lands where such operations aze prohibited by law (Section <br />34-32.5-115(4)(f), C.R.S.; <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 <br />(Section 34-32.5-120, C.R.S.) as determined through a Board fmding. <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.R.S. <br />Signed and dated this , day of V-Q- O.J <br />~~lo~~, i' m ~~s ~D~~_ <br />Applicant/Operator or Company Name <br />Signed: ~ + <br />Title: <br />State <br />Couni <br />If Corporation Attest (Seal) <br />\' <br />/_- ~ . <br />- ^ '.-~ - <br />Signed: ~~•~ <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrunment was ackno ledged before me this fir! -day of _ <br />by '.`~.~, (i, A as ~+.1 f f 1/ ~Z of <br />Notary <br />My <br />v <br />sionexpires:'__~1~~ / <br />SIGNAURES MUST BE IN BLUE INK <br />