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-~- <br />Certificafion: <br />As an aufhorued representative of the applicmrt, I hereby certify that the operation described has and the minimum <br />requirements of the following terms and conditions: <br />1. To the best of my knowledge, atl significant, valuable and permaneatman-made structure(s) inexistence 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 surdr operations are prohibited bylaw (Section <br />34-32.5-115(4xf), C.RS.; <br />3. As the applicanVoperator, I do not have a~ 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 />34-32.5-120, C.RSJ as determined through a Board finding. <br />4. I understand that statem~ts in the application are being made ands penalty of perjury and that false statements <br />made herein are punishable as a Class 1 misdemeanc~rpursuant to Section i8-8-503, CRS. <br />Signed and dated this lh~ day of ~t~ <br />~Y~2G r (A~t3T ~ ~ (/C <br />ApplicanU y Name <br />Signed: // / <br />Title: _ U~~i ~.~ re/1~.~~ <br />ff Corporation Attest (Seal) <br />Signed: L ~/- ~~'// ~ <br />~T- Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of ~ ~ ) <br />ss <br />Counh- of _ ~D(~lp{_~ ) <br />The f going ins t was acknowledged before me taus ID day of , <br />by as of <br />LfNDA S. BACH ~_ <br />NOTARY PUBLIC <br />STATE OF COLORADO ~ n' blic <br />My Commission Expires Oa117/2004 <br />My Commission expires: <br />SIGNATURES MUST BE i\ BLUE PII: <br />MiminWaeW~lComuacaou nzmo {~aurloop <br />