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<br /> <br />Certification: <br /> <br />As m authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements <br />of the following terms and conditions: <br />1. To the best of my Imowledge, all significant, valuable and permanwt man-made structure(s) in existence at the time this <br />application is filed, and located within 200 feet of the proposed affected area have bcen identthed in this application <br />(Section 34-32.5-115(4~e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-1 IS(4xf), <br />C.RS.; <br />3. As the applicanUoperator, I done[ 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 Eroraction oC Construction Materials (Section <br />34-32.5- I20, C.RS J as determined through a Board 5nding. <br />4. I understand that statements m the applicatotr are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.RS. <br />Signed and dated this ~_ day of I V 0 t) Ph"t ~e r , ~~. <br />~'lnb i l~ {~rPm t y ~'rfn e r cl-e,~ .~A, ~. <br />Applicant/Operator or Company Name <br />Signed: n y~ <br />Title: ~/~,1.~/ .4e.Y //I( A <br />State of CO ~o/!R-D 4 ) <br />ss <br />County of ~Pnrcr ) <br />r6rate Secretary or Equivalrnt <br />Town/City/County Cleric <br />The foregoing instrument was aclmowledged before me this f $ t day of 0 Y Pn'I b f r , ~p0 / , <br />by ~~R-~ ~. TilTr'LE as ~SS/Sf0/If".~crefx~ti of~joh,'~~ PrPmi,yCOnCrete. lv~. <br />pu1~#JDA S. EACH <br />NOTARY PUBLIC <br />Signed: <br />My Commiuion Expires Oa1172004 <br />SIGNATURES MUST BE IN BLUE INK <br />