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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 lmowledge, all significant, valuable and permanent man-made structure(s) in existence at the Gme <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 aze prohibited by law (Section <br />34-32.5-115(A)(f), C.R.S.; <br />3. As the applicanUoperator, 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 Extracfion of Construcfion Materials (Section <br />34-32.5-120, C.R.S.) as determined through a Boazd fmding. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statements <br />made herein aze punishable as a Class ]misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this ~ day of ~~ ~ G l-~ 2~Q Z . <br />/"~G2~~--rte 1N~~s ,R~~S <br />Appl' UOperator or any Name <br />Si ed: ~ <br />W C 21 ~NC • If Corporation <br />Signed: <br />Title: V \ C l~ ~6z• S 5. ~,.•c~J'Y - / tpM ~ ~ , sic n,+'T ~ o N <br />State of ~~~t7 ) <br />~/) ) ss <br />Cotmty of U/0~/~ <br />~~. <br />)eal) .~w <br />-' ~ i <br />~` f <br />-k~~-, -_ <br /> <br /> <br />The foregoing innstrument w~as~aclmowledged before me this 1r ~ day of ^ f1~ , o?o~., <br />by i~2:G~i.A6/ ~• r;~k:p.~ as 7/iti -~ y~~/o,.7` -~lBi~n~;. of /ii v i/U~i~ -(it/'if?.~. <br />- - ~ ~~~~~ <br />r - Notary Public <br />" . <br />My Commission expires: n2-~/o - OS- <br />SIGNATURES MUST BE IN BLUE INK <br />ionvoi <br />