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<br />~- <br />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 Imowledge, all signi5cant, 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 34-32.5-115(4){e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited bylaw (Section 34-32.5-115(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 Constmction Materials (Section <br />34-32.5-120, C.RS.) as determined through a Board finding. <br />4. I understand that statements in the application aze being made under penalty of perjury and that false statements made <br />herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />d <br />Signed and dated this ZZ ~ day of ~~ <br />sPuCi~o%9j/ ~l~rla/"Y <br />Applican Operator or Company Name <br />Signed: (,~~aQ~ G'7~ld>rr/ <br />Corporate Secretary or Equivalent <br /> <br />State of _ I.O ~O rgd.0 ~ <br />ss <br />County of 1"~1L°52- 1 <br />2poz <br />If Corporation Attest (Seal) <br />Signed: <br />Town/City/County Clerk <br />nd <br />The foregoing instrument was acknowledged before me this ZZ ~ day of re'~ , ~_, <br />by fQuc~o~p~t ~r9-r'1-~anGlr~~ as SG{e ProPrie~o~ of CG2,MP~o Cff7~t)P~ <br />~~, C_`~} <br />Notary Public <br />My Commission expires: 1 Z -I? `~ <br />SIGNATURES MUST BE IN BLUE INK _ <br />