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S <br />7 <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 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 aze prohibited by law (Section <br />34-32.5-115(4)(f), C.R.S.; <br />3. As the applicanUoperator, [ 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 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 y <br />ApplicanUOperator or Company Name <br />Signed~~ ~ V '~ \~0~-.~ <br />Title: ~ s~ ~ ~ 1 J~.CtiS <br />State of (%`'c'~(~~~-E~ ) <br />ty ~~ PQ.~~ j ss <br />Coun of. r' <br />If Corporation Attest (Seal) <br />Corporate <br />r- :,,. <br />~-.. <br />:Clerlr ,- <br />~.= <br />--- ,1 <br />The re oing instrument was acknowledged befgre me this day of ~1~ ~ ~~ ~. <br />by P. as _~~~il ~~i~9f `~2G~G~7~ <br />C- <br />~G~Paao~cti: <br />~; pTARY';.~- <br />tu: N •'~ = No ary Public <br />'~,~tpj; •p U B G' Q~' My Commission expires: ~, '~~ <br />SIGNATURES MUST BE IN BLUE INK <br />N:U9M.SHARE~VSFORMS~2823C012APP OLIO/99 <br />