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-~- <br />Certification: <br />As an aafhariud repres~tative of the applicant, I hereby certify that the operation described has met the minimum <br />requirem®ts of the following terms and conditicros: <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 wilt be located on lands where sudr operations are prolu'bited by law (Section <br />34-32.5-115(4){f}, C.RS.; <br />3. As the applicant/operator, I donut have a~ extcaction/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.RS.) as determined through a Board finding. <br />4. I mr~stand 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.R.S. <br />Signed and dated this day of - / l ~fi~ ZpU3 . - .~ j <br />W (ASlntiv~ci.ToN ~ouv.'tcr <br />Applicant/Opemtor ComparryName <br />Sign <br />Tide:l~wirmnn ~t oaf ~ lnu~nrt.i lr~mmiss~ov~ers <br />ll Corporation Attest {~) ~M ~! ` ~ - <br />J, ~ ~ ^~. <br />%- ? <br />Signed: ~f~l acY Cl n (Jl -`~ ~ - ~A rr~ ~_ <br />Corporate Secretary or Equivalent <br />State of eo~orc.~n ) <br />ss <br />County of (a~csln,..e~n ) <br />Town/City/County Clerk <br />The foregoing insamnent was aclmowledged before me this I~~~ day of ~1o v e",,,1-, ~.~.- ~ on3 , <br />by Q.u.e.,.,~•.... ~Va~c~ aS e-~.1` rw~c~.~.. of eoo.d... ~n.,,.~u~~s~~.~..u1 <br />•l . <br />_.®-- ~iotary Public <br />EAU g 1.~t''oo <br />qr a~ My Commission expires: ~- l I -,~oo'~ <br />SIGNATURES MUST BE IlV BLUE INK <br />M:~nkhaeKffim~G~hvctim ll2mc (lal5(r00q <br />