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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 />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.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section <br />34-32.5-115(4)(f), C.RS.; <br />3. As the applicenboperator, 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 Act for the Extraction of Construction Materials (Section <br />34-32.5-120, C.RSJ as determined through a Board finding. <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 pwsuant to Section 18-8-503, C.RS. <br />Signed and dated this ~ '-E + h day of ~-n (' ; ~ ~ ~0 <br />~ 1-YYl ~ 1'Yl /l ~ l 71 A (1~U <br />ApplicanU or Company Name <br />Signed: <br />Title: ChQ i 1'~ VYlO~In <br />State of ~~~ ~~ <br />S ., ,~~ Q ) ss. <br />C f IV~E~ <br />.~ <br />,. <br /> _.. ~_ <br /> -~ ~: <br /> <br />~~., <br />ounty o <br />The foregoing instrument was acknowledged before me this ~ day of ~ I ~~, by <br />as of / ~9,',/ <br />P; B <br />J~c'• ~TAq} 2 No Public <br />0,~~ ~ tary <br />My Commission expires: °~~~ <br />.' O <br />N~T AFB ``G• PO <br />SIG ,~. BE IN BLUE INK <br />M:lminldmeitrsfam6lC®mWion 112.da (10/15/200() <br />Idy Comau$$lua E7~If6S ~.~~ <br />If Corporation Attest (Seal) <br />Signed: <br />orporatg~s~t=fart' i <br />