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-~- <br />Certifiication: <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 />L To the best of my knowledge, all significant, valuable and permanent man-made structure(s) inexistence at the time <br />thus 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.R.S.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section <br />34-32.5-115(4)(f), C.RS.; <br />3. As the applicant/operator, I donothave a~ extractionlexpioration operations in the State of Colorado ciur'ently 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 statements <br />made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this ~ day of _ %~% GP= % a7~© <br />Rio Blanco County Road & Bridge If Corporation Attest (Seal) <br />ApplicandOperator or Company Name <br />Signed: ~ o ..~~-. ~ %~no~..~r..~+•-°+'wL Signed: <br />Title: _ Supervisor <br />Stateo:f Colorado ) <br />ss. <br />County of Rio Blanco ) <br />Corporate Secretary or Equivalent <br />TownJCirylCounty Clerl: <br />The foregoing instrument was acknowledged before me this ~ day of ~ ~~ . ~, by <br />Stanley Rasmussen as SllDg7,vy#, of Rio Blanco County Road & <br />' ' Win. J, l•+~y Bridge <br />"'~ '. .q <br />rr ~,~ °- ~'f'Ai' l2 <br />~; ~"° °y Notary Public <br />' °° ~'J~LIC ' <br />h,~s. 'o <br />;,; •. <br />~" ' %'Tf; • • .... • -'Q,P~ My Commission expires: ~ UrQS <br />OF COO <br />SIGNATURES MUST BE IN BLUE INK <br />M:~~~wsr~~c~~,~z.a~ oaisnoo» <br />