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F~ECE[~~~ <br />- ' - Nov o s Cori <br />Certification: ~ G'ivision of Minerals and Gsaioyy <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum <br />requirements of the following teens 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 3432.5-115(4xe), C.R.S.). <br />2. No mining opeaation wilt be located on lands where such operations are prohibited by law (Section <br />3432.5-115(4~f), C.RS.; <br />3. As the applicanUoperator, I do not have any extraction/exploration operations in the State of Colorado currently in <br />violation of the provisions of the Coorado Land Reclamation Act for the Extraction of Construction Materials (Section <br />3432.5-120, C.R.S.) as determined through a Board fording. <br />4. I understand that statements in the application are 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!//~J~,~~ ZC9i5 ~ . <br />Western Gravel, Inc. <br />ApplicanUOperator or Company Name <br />Signed: ~_' <br />Title: ~~~ <br />If Corporation Attest (Seal) <br />- .c <br />_= <br />Sign <br />.~ .,`'. <br />Corporate Secretary or uivalent <br />Town/City/County Clerk <br />State of L~JE =6'lC!~-C~-- ) <br />)~ <br />County of <br />The foregoing ins meat was aclmowledged before me this Z_ day of <br />by /3 as ~~ of <br />~~> G~ ~ <br />No ublic <br />My Commission expires: ~3-~c3 ~'`7 <br />SIGNATURES MUST BE IN BLUE INK <br />am~o~ <br />