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<br />Certification: <br />~s 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 knowledge, all significant, valuable and pemtanentman-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 by law (Section 34-32.5-115(4)(f), <br />C.RS.; <br />3. As the applicanboperator, 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 Construction Materials (Section <br />34-32.5-120, C.RS.) as determined through a Board finding. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statanents made <br />herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this ~ day of ~~~ . <br />S Grou Inc. dba United Companies of Mesa County-If Corporation Attest{$eal) <br />pplicanUOperator or Company Name <br />Signed: <br />Title: President <br />Signed• <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />State of ~D ~DV22~ ) -~~- <br />ss _ <br />County of e5a _ <br />The foregomg instmment was acknowledged before me(/~~''s " ~~` day of ~ U ~-c5'f' - ~OG ~j <br />by (ar`r`R ~~~berE., as f'V•~s~~e+t-t~ of 9( s4-(•e.SWGro4p. <br />ofFja ~e~ ~G~an~cs o <br />i°~ a ~ n~F <br />Notary Public <br />My Commission expires: ~ /iT <br />• SIGNATURES MUST BE IN BLUE INK <br />