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I <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 /> I. 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 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.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 Extraction of Construction Materials(Section <br /> 34-32.5-120, C.R.S.) 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 I misdemeanor pursuant to Section 18-8-503, C.R.S. <br /> Signed and dated this S�� day of 42LZCA Q,000 <br /> Aam, t -0 do c A If Corporation Attest(Seal) <br /> ApplicandQperator or Company Name <br /> Signed: / Signed: <br /> Corporate Secretary or Equivalent <br /> Title: �/ / Town/City/County Clerk <br /> State of L', v^q <Y n ) <br /> `f� ss <br /> County of W��Y�r ) <br /> The f regoing instrument w acknowledged before me this O day of � L- �, <br /> by as �t of On - �f <br /> YVONNE D. LUND <br /> NOTARY PUBLIC i+ <br /> ary Public <br /> STATE OF COLOR' I <br /> Ivry Commission expires: s- 7 ZGn 3 <br /> SIGNATURES MUST BE IN BLUE INK <br /> M..WJNS4URE\VSFORMS2923cof2.APP 02Jra99 <br />