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i <br />d <br />- 7 - <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation descnbed has met the minimum <br />requirements of the following [eons and conditions: <br />1. To the best of my knowledge, 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 area have been identified in this application <br />(Section 34-32.5-115(4)(e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prolu'bited by law (Section <br />34-32.5-115(4)(f), 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 COnStrUCtlOn Materials (Section <br />34-32.5-120, C.RSJ as determined through a Board finding. <br />4. I mrderstaad that statements in the application are being made ands penalty of perjury and that false statements <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, CRS. <br />Signed and dated this ~-7 day of Au ~ y ~ Zc~ 3 <br />~g t~NTE~P6~.'1=5~c5 at_L~- /ST~I~E Q~IKcl+i_ <br />ApplicautlOperator orComp N~ <br />Signed: <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Title: O V.l t.L a'L <br />Town/City/County Clerk <br />State of Cc l~ r4 ~e ) <br />,~~/ / ) ss <br />County of / / / n ~cr r ) <br />The forego//ing inslrtmrent was aclmowledged before me this ~ day of .5~7 , <br />by .~7¢v~ ,C~~•~- as ~W/!~t^ of rises <br />~° <br />c, <br />,~`; ~.: ~ Notary Public <br />- _~ . -' <br />- %~ ",.~ n My Commission expires: 5/Z ~d ~ <br />,~ <br />~.~~ <br />,__ SIGNATURES MUST BE Is'V BLUE INI: <br />M:~raue~vIIom~~camuacnou ~tzm~ poiurmot> <br />