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., <br />-~- <br />Certification: <br />Rs au authorized representative of the applicam, I hereby certify that the operation described has m~ the minimum <br />requirements of the follovaing 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 t~zthin 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. Iva mining operation ~n~ll be lo:.ated on lands where srch operations areprohibited b.' :au {Section <br />3. ,As the applicanUoperator, 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 tact for the Extraction of Construction Materials (Section <br />34-32.5-120, C.RS.1 as determined [hrouvh a Boazd fording. <br />4. I understand that stafenrents 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.RS. <br />Signed and dated this ~D ~ day of ~~.I%Yn-(!l/i/ ~.U D ~ . <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/CitylCounty Clerk <br />State of U~GCU~ <br />ss <br />County of <br />The forppeg~o,ing inslrtrruent w/~a-s aclorowledged <br />by V~ dfiYl. Tl• IN y'D~t as <br />.a <br />fi <br />,.- <br />U ` ». <br />°'•o~. .~' ~ .~ <br />`,. ..., <br />day of ~0 2; <br />of <br />4/Y{Ai Y <br />Notary Public <br />My Commissionexpires: ~ 0~0 <br />SIGNATURES MUST BE IlV BLUE INK <br />tr:~~~ro,~~w~+~ nzaa ponsnm» <br />