2001-12-12_REVISION - M1983067 ‎(9)‎

• Permit No: M1983067
• IBM Index Class Name: Revision
• Doc Date: 12/12/2001
• Doc Name: CERTIFICATION
• Type & Sequence: AM1
• Media Type: D
• Archive: No

IIIIIIIIIIIIIIIIIII • • ~~~~"3~~''~"~~
999 - ' - DEC 122001
Certification:
... ~., in ai dAi¢emis and GeoloBY
As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum
requirements of the following terms and conditions:
1. To the best of my knowledge, all significant, valuable and permanent man-made structure(s) in existence at the time
this application is filed, and located within 200 feet of the proposed affected azea have been identified in this application
(Section 34-32.5-115(4)(e), C.R.S.).
2. No muting operation will be located on lands where such operations aze prohibited by law (Section
34-32.5-115(4)(fl, C.R.S.;
3. As the applicandoperator, I do not have any extraction/exploration operations in the State of Colorado currently in
violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Conswction Materials (Section
34-32.5-120, C.R.S.) as determined through a Board fmding.
4. I understand that statements in the application are being made under penalty of perjury and that false statements
made herein aze punishable as a Class 1 m((i~sdemeanor pursuant to Section 18-8~50~3,~C.R.S. _
Signed and dated this /~ day of Al.OPO~~sP.r io rs~. _ _ .
~O ~~0-E+~~ ~ -b7f!'DO Q ~c~e- If Corporation Attest (Seal)
ApplicanUOperator or Company ame
Signed: ,
Titre: .CL.n,td'~ N..~t.~cX /~~.~- l
Signed: ~ "~i U/ /
~I'~il orporate Secretary or Equivalent
Town/CitylCounty Clerk
State of l_(9f~/2~ )
ss
County of ~.uJ9Pil/ )
The foregoing in Vumen4was acknowledged before me
by as
~~n r./
day of I,nlpva.,.,_Oa~ri ate/
!~A of ~n /~Do~~ ~'bxe-u~c~-~-
QOP~pTARI- O / ~1
NT::A~ \G .:O Notary Public
-v~,•.,••BL• .PQO
~ Op CO~-O My Commission expires:
My Commission E~Ires~~'r
SIGNATURES MUST BE IN BLUE INK
M:U1WtBDCN1INPORMS~2823C012.APP 10/17/01