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Certification: <br /> As an authorized representative of the applicant,I hereby certify that the operation described has met the minimum requirements <br /> 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 time this <br /> application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br /> (Section 3.3-32.5-115(4)(e), C.RS.), <br /> 2. No nuning operation will be located on lands where such operations are prohibited by law(Section 34-32.5-1 L5(4)(f), <br /> C.RS.; <br /> 3. As the applicant/operator,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 /> 34-32.5-12 0, C.RS.) as determined through a Board finding. <br /> 4. I understand that statements in the application are being made under penalty of perjury and that false statements made <br /> herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503,C.RS. <br /> Signed and dated this s3* day of lV4k� 2cb <br /> n04T �o„�y-rye aF Lphtr-t rss�o ti1s If Corporation Attest(Seal) <br /> ApplicannUOperator or Company Name <br /> Signe,Fl_ Signed: Qi ' <br /> Title: » K -Tewmti lCounty Clerk <br /> State of a 016 <br /> ss <br /> County of�/�' Y7 0"-)7- <br /> The foregoing instrument was acknowledged before me this _day of o?0C)) <br /> by as of <br /> Notary Public <br /> My Commission Expires <br /> My Commission expires:09-23-2002 <br /> SIGNATURES MUST BE IN BLUE INK <br />