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-~- <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 iderttified m this application <br />(Section 34-32.5-115(4)(e), C.RS.). <br />2. No milting operation will be located on lands where such operations aze prohibited by law (Section <br />34-32.5-115(4)(f), C.RS.; <br />3. As the applicamt/operator, I do not have any extraction/exploration operations in the State of Colorado currently in <br />violation of Ute 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 fording. <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 2~f~ day of~ 200 ¢- <br />P ~ G If Corporation Attest (Seal) <br />ApplicanU eratar or%C~o~m~pa~ Name <br />Signed: .-~'~~L%y % Signed: <br />Corporate Secretary or Equivalent <br />Title: <br />State of <br />County of <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged be o~ii~s ZT ~ day of lT~ ~ oo~F , by <br />. ~ s a <br />Notary Pubhc <br />My Commission expires: /~~,T oO;S~ <br />SIGNATURES MUST BE IN BLUE INK <br />M:~minWwe~v~me~~crosn~wion ~ ~z.a« Oa~snooi> <br />