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-~- <br />Certification: <br />As an authorized representative of the applicam, l hereby certify that the operation described has met the min;,m,m <br />requirements of the following terms and conditions: <br />1. To the best of my knowledge, all significant, valuable and pennanentman-made shuctuze(s) inexistence at the tune <br />this application is filed, and located within 200 feet of the proposed affected area ha~re been identified in this application <br />(Section 34-32.5-I IS(4)(e), C.RS.). <br />2. ?vo mining operation will be Io~^ted on lands wfiere Bach operations are prohibited by iaar {Section <br />34-~2._•-115(4)af;•, C.RS.; <br />3. As the applicandoperator, I donor have any extraction/exploration operations in the State of Colorado currently in <br />violation of the pro~~sions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section <br />34-325-120, C.RS.) as determined through a Board finding. <br />4. I understand that statanearts in the appliption are being made under penalty of perjury and that false statements <br />made herein are punishable as a Class 1 misdemeanor pursuant to Set~on 18-8-503, C.RS. <br />Signed and dated this ~D ~ day of ~~~ 2.U D ~ . <br />If Corporaion Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />State of U~Gt-tJ" <br />ss <br />County of Q/~. <br />The for~~egLLoing instr~''u))m~t wras acknowledged <br />by VZ~ !}GYt_ 7C• `LiJ D-DL( as <br /> <br />.•- <br />„o-,~.. <br />.- »: <br />°•. <br />6~ Town/City/Conniy Clerk <br />of o~0 2; <br />~ of <br />Notary Public <br />My Coffinission expires: ~ a2~ <br />SIGNATURES MUST BE IN BLUE INK <br />M:~~~.~,~~wu~oo m2aa pa,vzm,~ <br />