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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 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 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(4)(f), C.R.S.; <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 Extracflon of Construction 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 aze being made under penalty of perjury and that false statements <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. <br />Signed and dated this ~ day of l~2 6 r ~.. ~ ~., d ~ a ~- . <br />_ p .S eR1 <br />~ ra n s ~~ /~ iu o F l u. e L to If Corporation Attest (Seal) <br />ApplicanUOperator or Company Name <br />Signed:.. ~/ //~Q~---ate--~ <br />Title: ~ ~ ~~ e- P r v) r d ~-in fi <br />i <br />State of o (L ]QCCC~ <br />/ ) ss <br />County of ~( ~ny ) <br />The foregoing instrumen't' w s acknowledged <br />by ( -- ., ~ , ~K as <br />~~.o, <br />me this <br />R, -n. <br />a~ow.E`,..... Sk~`~`y, <br />re : ~apTAgy ~: v <br />~~- <br />~'•'• pUBLiG;•Q <br />~ •.. <br />i~~~9,F OF COQ-~PP~C <br />Signed: iv~~ /~ ~h~ <br />nssis~ crv rCorporate Secretary ~~ <br />~ ~y <br />zcdc ~f <br /> <br />Town/City/County Clerk <br />~ef~~r t ts~ 6C c~ <br />CC i,. ~ <br />Notary Pub~c ~`~ ,v <br />My Commission expires: ~ ' (~ ' ~~ <br />SIGNATURES MUST BE IN BLUE INK <br />Nt:vtiw~enc~uaroxMS~.azscoiz.nre ioinioi <br />